claim
A formal request made by an insured person or their healthcare provider to an insurance company asking for payment or coverage for a medical service.
A claim is the administrative vehicle through which medical services are processed for payment. If a claim is approved, the insurer pays the doctor; if denied, the patient may owe the balance.
Word relationships
- request: A request is a general ask, whereas a claim is a formal, contractually backed demand for payment.
- petition: A petition is a formal request to an authority, usually signed by many, whereas a claim is an individual legal/financial demand.
Commonly confused with
- bill: A bill is what the doctor sends showing what is owed; a claim is what is sent to the insurance company to get them to pay that bill.
Word family
- claimant (noun): A person who makes an insurance claim.
- unclaimed (adjective): Not claimed or demanded.
Collocations
- file a claim
- submit a claim
- deny a claim
- process a claim
Example sentences
- "The hospital submitted a claim to the insurance company, but it was rejected due to an incorrect billing code." A notification of a billing issue.
- "If you receive care from an out-of-network doctor, you may need to file a claim yourself to get reimbursed." An instruction for patients filing their own paperwork.
Memory hook
When you make a claim, you 'clamor' (shout) for your money. A claim is a shout for the money you are owed.
When not to use
Do not use 'claim' to mean an unproven statement (e.g., 'he made a claim about his health') when discussing the administrative process of insurance billing.
Fun facts
- In ancient times, a 'claim' was literally a loud public shout to assert ownership of land or property in front of witnesses.
Also appears in
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