What is a claim?
A claim is a bill for medical services, sent to your insurance company.
The insurance company will process the claim, pay its share and let you know how much you may owe the health care provider.
A claim is how you use your health insurance. When you have a medical event, you or someone on your behalf (such as a doctor) submits a claim to the insurance company that requests payment for medical goods or services.
The insurance company will then process the claim by matching it against the details of your policy, such as your deductible, your coinsurance, the network status of your health care provider and your plan benefits.
After processing your claim, the insurance company will pay the health care provider its share of the bill (or will pay you directly if it's a reimbursement claim). You would then be responsible for paying the balance, if any. The insurance company will let you know how much of the claim it paid and what you may owe through an Explanation of Benefits (EOB) statement.