A claim is a request for us to pay for covered benefits under your plan. You or your provider must file a claim before we can reimburse costs according to your plan’s coverage. Most claims create an Explanation of Benefits (EOB) we’ll send to you.
There are different types of HealthPartners claims, depending on the plans or products you have, including:
Many claims are submitted automatically on your behalf, but claims you submit yourself generally take us about four to six weeks to process. Please note:
If you have a question about how to file a claim with us, we’re here to help. Call Member Services at the number on the back of your member ID card or send us a message .
These are claims related to medical care, services or products covered under your HealthPartners medical insurance plan.
In-network providers are required to submit claims on your behalf. If your provider is in network, check to make sure they have your current insurance information on file. If you need further assistance, call Member Services at the number on the back of your member ID card or send us a message .
If you used an out-of-network provider for covered care, services or products, ask if they’ll submit a claim to us on your behalf. If they won’t, you can send us an itemized statement or detailed receipt (and supporting documentation) to get reimbursed for amounts you owe out of pocket that are covered by your plan. You may need to work with your provider to get the necessary information to file your claim.
These are claims related to dental care, services or products covered under your HealthPartners dental insurance or Medicare plan.
In-network providers are required to submit claims on your behalf. If your provider is in network, check to make sure they have your current insurance information on file. If you need further assistance, call Member Services at the number on the back of your member ID card or send us a message .
If you used an out-of-network provider for covered care, services or products, ask if they’ll submit a claim to us on your behalf. If they won’t, the out-of-network claim process depends on whether you have:
Send us an itemized statement or detailed receipt (and supporting documentation) to get reimbursed for amounts you owe out of pocket that are covered by your plan. You may need to work with your provider to get the necessary information to file your claim.
If you need to get reimbursed for amounts you owe out of pocket that are covered by your Medicare plan, you can send us a request:
These are claims related to prescription medicines covered under your HealthPartners medical insurance or HealthPartners prescription drug plan. (Please note that some employers use insurers besides HealthPartners to cover prescription medicines. If this applies to you, you’ll have a separate ID card from a separate company for your pharmacy benefits, and you’ll need to contact that company regarding how to submit a claim.)
Generally, your HealthPartners insurance will be checked when you fill your prescription at the pharmacy counter or receive a prescription in a medical facility. This creates an automatic claim, and the price you pay out of pocket factors in your insurance benefits.
If your insurance wasn’t checked when you filled your prescription and you paid full price out of pocket for a prescription, you can send us a claim to get reimbursed under your coverage:
These are claims related to an FSA or HRA administered through HealthPartners.
If you have a HealthPartners insurance plan in addition to a HealthPartners-administered FSA or HRA, you’ll automatically receive a reimbursement equal to what you owe your provider out of pocket (after your insurance benefits are factored in). You can opt out of automatic claims submissions – download the form through our member forms page , and return it to us.
If you didn’t use your HealthPartners insurance, or if you don’t have HealthPartners insurance, you can also submit a manual FSA or HRA claim. Your claim must be for eligible medical expenses, and documentation is required.
You must have sufficient funds in your FSA or HRA for any claim, automatic or manual, to process in full.
Some of our group plans through an employer or other organization include travel benefit coverage.
Under this benefit, when you or someone on your plan receives a covered medical service that isn’t available within a geographic distance specified by your plan, we’ll pay for eligible travel expenses – so long as the covered service was performed legally (according to local laws where the service took place) within the United States:
If you have additional questions about claims, call Member Services at the number on the back of your member ID card or send us a message . We’re ready to help.
As part of our coverage criteria policies , some care, services or medicine may require prior authorization before they’re covered. For more information and details, contact Member Services.
The easiest way to see your insurance plan details is to sign in to your HealthPartners account . If you have questions about your coverage, contact Member Services.
Check out these helpful guides to some claims questions we hear most often:
Find more information about submitting claims at our provider portal .