How you file a claim depends on what is written in your PPO plan. Before you sign up for a health insurance plan, you will be given a choice of single or multiple scope process. A PPO plan has pre-service and urgent claim processes. Pre-service claim is getting an approval first before using a medical service or seeing a doctor. It usually takes 15-30 days from the day the insurance company received your request. The urgent claim, on the other hand, usually takes only three business days upon receipt of your appeal or two days after the claim has been filed. In some cases, you can get a response within 36 hours depending on the urgency of the situation. You, your doctor or an authorized representative can submit the claim to the insurance carriers. Most insurance carriers’ health cards indicate a customer or member service number which you can use in case of an emergency and other health insurance concerns. You can either call up the hotline or send a letter, which is usually advised, to the insurance company. If you have questions regarding the medical bill, you can request a copy for your review. It takes 180 days before you can receive the requested records. Make sure that you provide the important details such as the company name (if you are in a group health plan) and identification or Social Security number. It must be clear in your PPO plan what types of appeal and claim you can request. This is important for those individuals who need long-term care and may not always have cash to spare for out-of-pocket epenses. - June 26, 2009 @ 3:29pm