A health insurance deductible is the amount you pay out-of-pocket for healthcare services before your insurance plan begins to pay its share. For example, if your deductible is $1,000, you must pay the first $1,000 of your medical expenses. After you meet your deductible, your insurance will start covering a portion of your costs, typically involving copayments or coinsurance for further services. Deductibles will vary by plan.
Understanding claims, billing and payments.
How long does it take to process a claim?
Once a claim is received from your provider, the claims status will show as “In Progress” in your online Select Health account until it is processed. Checking the status of a claim is easy through your member account or the Select Health mobile app.
Understanding your out-of-pocket expenses.
What you owe can be impacted by your plan's coinsurance or copay. You will likely be responsible for at least some of your bill if you reached your deductible or out-of-pocket maximum.
Coinsurance is a cost-sharing arrangement where you are responsible for paying a certain percentage of your total medical costs. For example, if your health plan has an 80/20 coinsurance structure, Select Health will cover 80% of all eligible expenses. You will only pay the remaining 20%.
A copay is a fixed amount you pay the doctor, pharmacy, or facility toward the total cost of healthcare services. Most plans offer lower copays for Primary Care Doctors and higher copays for secondary care providers.
An out-of-pocket maximum (or out-of-pocket limit) is the maximum amount you could pay for healthcare services each year. The amount you pay toward your deductible, coinsurance, and copays all contribute to your out-of-pocket maximum. Once your out-of-pocket maximum is reached, Select Health will cover 100% of the cost of eligible services for the rest of the year or policy period.
Still have questions?
*In rare cases, you may have to submit a claim yourself. You can also choose to submit a claim in place of your provider. Generally, claims must be submitted within one year from the date of service. You can find the Claims Reimbursement Form, with additional instructions, here.
Checking the status of a claim is easy through your member account or the Select Health mobile app (Android / iOS). After logging in, navigate to the Claims page from where you can see your claim status. From here, you can see the current status of your claim. You can also filter claims by type, member, or date.
There are 3 statuses that you need to be aware of:
- In Process – The claim is pending. It may have been recently submitted or we may be gathering additional information.
- Processed – The claim has been successfully processed. When a claim is approved, you will be able to view a summary of the details and see the Explanation of Benefits (EOB).
- Denied – The claim cannot be approved as submitted. This may occur for many reasons, including missing information, duplicate claims or services, the service not being covered, or the time limit for filing has expired. If you find a claim has been denied, please contact one of our member services agents for more information.
Claims adjustments are changes to the amount Select Health has paid to a provider. This can happen even after a claim has been approved or denied. If an adjustment happens on one of your claims, you will receive an updated Explanation of Benefits once the claim has been reprocessed. During this time, the claim status will return to “In Process.”
