Health insurance claims are often delayed — or rejected — not because the treatment wasn't covered, but because the supporting documentation was incomplete. Knowing which records to gather, how to organise them and what to do when a claim is disputed can make the difference between a smooth reimbursement and a months-long ordeal.
This guide covers the most common types of health insurance claims and the documents they require.
What insurers typically ask for
The exact documents required vary by insurer, policy and type of claim, but most will ask for some combination of the following:
- Claim form — usually downloadable from the insurer's website or app
- Original or certified copies of invoices and receipts from the provider
- Referral letter if the treatment was with a specialist — some policies require this
- Discharge summary or clinical notes for inpatient care
- Lab or radiology reports if tests were performed
- Prescription with the drug name, dose and duration for medication claims
- Pre-authorisation number if prior approval was required
- Your policy number and any relevant group or employer scheme number
Organising your documents before you claim
The most common reason claims take longer than necessary is missing documentation that has to be chased after the fact. Starting a claim folder for each episode of care — even before you know whether you'll be claiming — saves significant time.
- Keep a digital copy of every invoice on the day you receive it
- Ask for a coded medical invoice — insurers need the ICD-10 or CPT code, not just a description
- Keep a copy of every referral letter and specialist report
- Note the date, provider, diagnosis and treatment for each episode
Submitting a claim
Most insurers now accept online or app-based submissions. Upload clear PDF copies rather than phone photos where possible — blurry or cut-off images are a common cause of delay. Check every page for legibility before submitting.
Note the claim reference number and submission date. If you haven't heard within the timeframe stated in your policy (usually 10–30 business days), follow up in writing so there is a record.
If your claim is rejected
A rejection letter will cite a reason — for example 'pre-existing condition', 'not covered under your plan', or 'missing documentation'. Read it carefully before assuming the insurer is right.
If the rejection is for missing documents, gather what's needed and resubmit promptly. If you believe the rejection is incorrect, write a formal appeal citing the specific policy clause that you believe covers the treatment. Keep copies of everything you send.
How Looms helps with insurance claims
Having all your records in one place dramatically speeds up the documentation phase of a claim. From Looms, you can download any lab result, medical report or prescription as a PDF, and create a time-limited share link that lets an insurer or clinic access exactly the documents they need without you having to send multiple emails. If you need to gather records from a provider first, our guide on how to request your medical records walks through that process.