If you paid a medical bill yourself, the reimbursement form is how you ask the plan to pay you back.
Sometimes a provider does not bill the plan, or you pay up front for medical, dental, vision or prescription care. The reimbursement request form lets you send the receipt to the plan and ask for the covered part back.
Three common reasons for a reimbursement request.
The Provider Did Not Bill the Plan
Some offices ask for payment at the visit and leave the claim to you. You send in the bill, and the plan pays you if the service is covered. Keep every receipt and note the date, since the plan will usually want proof of what you paid.
You Paid for a Prescription Out of Pocket
If you filled a prescription without using your plan card, you can ask for reimbursement. Your plan sets what it pays and whether the drug is covered. Keep the pharmacy receipt showing the drug name and what you paid, and check your plan’s drug list first.
Dental and Vision Services
The same form covers dental and vision care you paid for, subject to the benefits in those plans. Dental and vision plans may use their own claim rules and deadlines, so check each benefit separately before you send anything in. Keep copies of what you submit.
A complete request gets paid faster.
An Itemized Bill or Receipt
It should show the provider, the patient, the date of service, what was done and what you paid. A card slip alone usually is not enough. Ask the provider’s office for an itemized statement at the time of service so you do not have to request it later.
The Other Plan’s Explanation of Benefits
If another plan paid first, include its statement. See coordination of benefits.
Claim Filing Deadlines
Plans set a deadline for sending claims. Check yours, because late requests can be refused. Your plan documents or the carrier’s member site will list the date. Send claims promptly after the visit instead of waiting to collect several, and keep a copy of what you submitted.
The mistakes that cause a request to be returned.
Missing Dates or Provider Details
A receipt without a service date or a provider name cannot be matched to a covered benefit. Check each receipt before sending the form, and ask the provider to correct or reissue anything incomplete. Submitting a complete package the first time avoids a back and forth.
Services the Plan Does Not Cover
Reimbursement follows the plan. If the service is not covered, the plan will not pay it back, even with a perfect form. If you are unsure whether a service is covered, check your plan summary or call the number on your card before you pay.
Paid, but Not Yet Approved
Some services need approval first. See referrals and prior authorizations. If approval was required and not obtained, the plan may deny the claim even though you paid for the service. Check before scheduling, and ask the provider’s office to help if you are not sure.
What people ask about reimbursement requests.
How long does it take?
It depends on the plan and how complete the request is. A complete request with an itemized bill is the quickest route.
Will I get the full amount back?
Not necessarily. The plan pays according to its benefits, and your deductible and coinsurance still apply.
Should I use the plan’s network?
Network providers usually bill the plan directly, which avoids the form. Out-of-network care can pay less.
Is this the same as an HRA or FSA claim?
No. This form is for your health plan. Employer-funded accounts have their own claim process and rules.
What if the request is denied?
You can usually appeal. See denied claims and appeals.
Can CFH help with a denied request?
For the accounts we serve, yes, through our claims advocacy work.
Related reading: Coordination of benefits · Denied claims and appeals · Reading your plan documents · Claims advocacy
Related reading: Explanation of benefits (EOB)
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