Health insurance is something everyone has to use at one time or another. That means filing health insurance claims. Claims are sometimes paid in weeks and sometimes it takes months. The reason behind the length of time varies depending on what information might have been left off.

There is a process that all claims go through from start to finish. To start with, the doctor, clinic, or hospital will usually file the claim for you. If the provider rendering services is in the network your policy uses, they are required to file the claim for you.

Once your claim hits the claims office a couple of things could happen. Health insurance claims that are submitted electronically by the provider will sometimes go through the payment process in an automated system. Lots of claims do go through without a problem and payment is released within a few days. If the automated system cannot read or understand any part of the claim it will be kicked out for review by a live processor. All paper submitted claims will also be reviewed by a claims processor.

All claims have a time limit that is mandated by the state board of insurance. This means that an insurance company has only a certain number of days to start work on the claim or pay a penalty. This does not mean the claim has to be completed; it just means that the claim has to be started by a processor.

Now that the claim is in the hands of the processor the program used by the insurance company starts reading the diagnosis codes and procedures codes to determine the allowed amount they will pay from. Each provider has pre-loaded amounts they are allowed for each procedure in the computer program. Once the processor answers any questions the computer may ask for assistance on, the claim is released, and a check is cut with 10 business days.

After the check is cut, a copy of the EOB, which stands for explanation of benefits, is sent along to the provider with the check. A copy of this EOB is also sent to the member. It is extremely important to check these explanations to be sure the claim paid correctly. Everyone makes mistakes occasionally, even the insurance company.

Understanding your health insurance benefits will help you to know if the claim is being paid correctly. If there are any questions, don't hesitate to call customer service and get the answers. Claims should not take months to complete unless there is a problem. Have your customer service number and benefits booklet close by and be sure you get the benefits you deserve.