This content is for general informational purposes and does not constitute medical, legal, or financial advice. Healthcare rules and costs change annually. Last reviewed: January 1, 2025. Always verify current details with your insurer, employer, or a licensed healthcare navigator.
Insurance Claim
A request submitted to your insurer to pay for a medical service you received.
Full Definition
An insurance claim is a formal request — submitted by your provider or by you — asking your health insurance company to pay for covered medical services. Most providers submit claims electronically on your behalf. Your insurer reviews the claim, applies your deductible and cost-sharing, and sends an Explanation of Benefits (EOB) showing what was covered and what you owe. Claims can be denied; you have the right to appeal.
Real-World Example
After your doctor's visit, the office submits a claim to your insurer. Your insurer processes it and sends you an EOB showing they paid $140 and you owe a $30 copay. The doctor's office then bills you that $30.
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