How Health Insurance Claims Work. At that time, the insured person can make a request to the insurance company to cover their medical costs. How stuff works gives the definition of a healthcare claim as “a bill for health care services that your health care provider turns into the insurance company for payment.”.
If it’s covered by the plan, the next step the insurer does is to find out if the hospital where the insured is. The health insurance verification process is a series of steps that checks whether or not the patient admitted has the ability to make a reimbursable claim to their health insurance provider. The amount physicians are paid differs depending on the specific payer contract and/or fee schedule.