• Review your policy or employee booklet carefully to be sure the service in question is covered.
• Follow any managed care rules, including pre-certification requirements and use of network providers.
• Give claim forms to the provider, with your policy number and other identifying information.

• Find out if your provider submits the claim for you or if you need to do it.
• If you need to do it, review the information to be sure it is complete and correct.
• File it as soon as you get the bill from the provider.
• Send it to the right address.
• Keep a copy for your reference.

Time frame to process your claim. Delaware's "Prompt Payment" regulation basically requires the insurance company to pay a claim, reject it or ask for more information within 30 days. It also requires that a health insurance only ask for additional information once, rather than repeatedly making requests. The company must send you an explanation of benefits that explains its decision.

• If you assigned benefits to the provider, the benefit check will be sent directly to the provider.
• You will pay any deductibles and co-insurance.
• If you did not assign the benefits, the check will come to you and you will need to pay your providers for the entire amount.

• The reason for denial should be stated on your explanation of benefits.
• If you disagree with the basis stated for denial, check your policy or employee booklet for the company's appeal procedures.
• The company should be able to answer procedural questions about appeals over the phone.
• Your appeal should be in writing and may require information from your doctor.