Claim

Definition: A formal request for the insurer to pay for healthcare services rendered. In most cases, the healthcare provider files a claim with the insurance company at the time of service, and the insurance company pays the provider directly. In some cases, the insured must pay the provider for his or her services and fill out a claims form for reimbursement. If your insurance company refuses to pay your healthcare provider for his or her services, you may be able to appeal their decision to deny payment. Learn how to resolve your health insurance claims dispute.