What Is Insurance Reimbursement?

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  • Written By: R. Kimball
  • Edited By: A. Joseph
  • Last Modified Date: 04 November 2014
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Insurance reimbursement is when one is reimbursed in accordance with an insurance policy for expenses that have been incurred and are covered under the policy. These policies might be for medical or dental insurance, homeowners insurance, automobile insurance or other types of insurance. Some types of insurance reimbursement are paid to the insured person under the insurance policy. Other types of reimbursements are paid directly to the provider of a certain good or service after the provider has submitted an assignment of benefits document to the insurance company.

Each insurance policy has specific items for which expenses are covered, not covered or covered in part. It is the insured or the assignee’s responsibility to provide the insurance company with the appropriate information so that the insurance company can determine what is or is not covered under the particular policy. The insurance company will provide an explanation of benefits that documents how reimbursed expenses were calculated. This explanation of benefits document is the insurance company’s response to the insured or its assignee’s request for reimbursement.


It is imperative that the insured or the insured’s assignee, such as a doctor’s office, complete the insurance company’s forms accurately in order to receive the largest available insurance reimbursement from the insurance company. As an insured selects a medical provider, for example, it is a good idea for him or her to learn whether this provider has previously worked with his or her insurance company. Each insurance company has specific pieces of information that it looks for in an insurance reimbursement application. If one’s application is missing this information, then his or her initial request for reimbursement might be denied. One can always appeal the denial, but doing so takes more time.

If a selected medical provider does not work with a specific insurance company, the insured is likely to have to pay for said medical services at the time services are rendered. It is then up to the insured to file with the insurance company for insurance reimbursement. Each policy has different requirements for co-payments and annual minimums to be met prior to reaching eligibility for reimbursement. When the insured pays for medical services out of pocket and then receives reimbursement, it can be several months before the insured receives the amounts due based on the insured’s policy.

When a specific medical provider works directly with an insurance company, the insured is required to sign an assignment of benefits document with the medical provider. The insured might be required to make a co-payment for services rendered on the date such services are provided. The medical provider is then responsible for working with the insurance company to receive its insurance reimbursement payment.


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