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.
Claims and billing
Understanding how claims and billing work can help you make informed healthcare decisions and avoid unexpected costs.
Need to submit a claim?
If you need to submit a claim for reimbursement, complete a Claim Reimbursement Form. Select Health can only reimburse claims for covered services, procedures, and diagnoses, and claims must be submitted within one year of the date of service. If you're not sure whether your service is covered, contact Member Services for help before submitting your claim.
Understand 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?
Check out our frequently asked questions or call Member Services.
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.”
When you or your provider submit a claim, we send an Explanation of Benefits (EOB) that shows how your claim was processed. An EOB is not a bill. It helps you understand how your plan benefits were applied to a specific service.
Your EOB includes details such as:
- The date you received care
- The amount your provider billed
- The amount covered by your plan
- The amount Select Health paid
- Any amount you may owe your provider
When you receive an EOB, review it carefully and compare it with any bill or statement from your provider. This can help you verify that the services and charges are accurate and understand what, if anything, you may need to pay.
Coordination of benefits (COB) is a process used to determine the order in which multiple insurance policies will pay for a claim when an individual is covered by more than one policy. This situation often arises for dependents who are covered under both parents’ plans or when someone has both a primary and secondary insurance policy.
