MedBillCheckup
Check my bill
Menu

Paid a medical bill yourself? How to get your insurer to pay you back

How to send your own claim after you paid: what to attach, the deadlines, and what to do if the plan pays less.

By the MedBillCheckup team · Updated October 30, 2026 · About 7 minutes to read

Have your bill with you? Read it free in MedBillCheckup, a private medical bill checker that reads the bill on your device, and see a free preview of what may be worth asking about.

Check my bill, free

If you paid a doctor or hospital yourself, you can usually ask your insurer to pay its share by sending your own claim. First ask the provider to send the claim. If it will not, send your plan's claim form with an itemized bill and proof of payment. Your plan decides what it pays, and its own documents say where to send the claim and how long you have.

The rules below are federal. Your plan documents give your plan's exact steps. This is general information, not legal advice.

First, ask the provider to send the claim

The simplest route is the provider's billing office. Ask it to send the claim to your insurer for the date you paid. If the insurer then pays the provider, the provider may owe you what you paid above your share, and some states set a deadline for that refund: see patient refund laws by state.

With Original Medicare, Medicare.gov says the law requires your doctor, provider or supplier to file Medicare claims for covered services and supplies you get, and that you should only need to file a claim yourself in very rare cases. A provider who does not accept assignment should still submit the claim for covered services and can't charge you for submitting it (Medicare.gov). If no claim was filed for you, Medicare.gov says to contact the provider and ask it to file one.

With a Medicare Advantage plan, in-network doctors, suppliers and pharmacies will usually submit the claim directly to your plan (Medicare.gov).

What to send with your own claim

If the provider will not file, or you paid an out-of-network provider that does not bill your plan, you can send the claim yourself. For a plan through a private employer, the Department of Labor says the plan's summary plan description or claims booklet must say where to file, what to file and whom to contact. The member services number on your insurance card can tell you which form to use.

What insurers usually ask for:

  • The claim form, filled in and signed.
  • An itemized bill: each service with its date, place, description and charge, and the provider's name and address. Medicare lists these for its own form. Some insurers also ask for procedure or service codes, if applicable (UnitedHealthcare's form is one example). Our free itemized bill letter asks the provider for it.
  • Proof of payment, such as a receipt. Aetna's claim instructions, for example, say to attach itemized bills with your receipts for proof of payment.
  • Another plan's Explanation of Benefits, if another plan, Medicare included, already processed the claim (Aetna's instructions, for example).

Keep a copy of everything you send, and note the date. The Department of Labor says plans generally cannot charge any money for filing claims and appeals.

Original Medicare: form CMS-1490S

If you had to pay out of pocket because your provider refused to submit a claim, Medicare.gov says you have to submit your own. The form is the Patient's Request for Medical Payment, form CMS-1490S.

  1. Tick one reason on the form: the provider refused to file, is unable to file, or is not enrolled with Medicare.
  2. Attach the itemized bill. The form says Medicare needs it to process the claim. Medicare.gov also asks for a letter explaining why you are submitting the claim yourself.
  3. Mail it to the Medicare Administrative Contractor address for your state, in the address table that comes with the form.
  4. Keep a copy, and allow at least 60 days for Medicare to receive and process your request (CMS).

The deadline is 12 months after the date of service, unless an exception applies, and Medicare won't pay its share of a claim filed later (Medicare.gov, 42 CFR 424.44). If the provider has not filed, Medicare.gov says to call 1-800-MEDICARE and ask for the exact time limit for your service. Medicare will not process your own request for diabetic test strips, Part B drugs, or items paid under its competitive bidding program for medical equipment and supplies. And Medicare won't pay for care from a provider who has opted out of Medicare, except in emergencies.

With a Medicare Advantage plan, ask the plan. Federal rules say requests for payment go to the plan in writing, unless the plan accepts verbal requests (42 CFR 422.568).

Have your bill in front of you? Check it now, free. Your bill file stays on your device.

Check my bill, free

A plan through your job

The Department of Labor calls a request for reimbursement after care a post-service claim, and says most group health claims are post-service claims. Before you file, read your summary plan description: it must describe how to file and the time limits.

  • The decision must come within a reasonable time and no later than 30 days after the plan receives the claim. The plan may extend that once by up to 15 days for reasons beyond its control.
  • The clock starts when you file under the plan's rules, even if something is missing (29 CFR 2560.503-1). If the plan asks for more information, you have at least 45 days to send it.
  • Paying less counts: the Department of Labor says paying anything less than 100 percent of a claim is a denial in part.
  • A denial notice must give the specific reasons, the plan provision it relies on, what is missing if the claim lacks information, and how to appeal.

These rules generally apply to plans from private employers. Plans sponsored by government or most religious bodies have exceptions (Department of Labor).

A Marketplace or other individual plan

Insurers that sell individual plans, Marketplace plans included, must follow the same federal claims and appeals rules as plans through a job, with some exceptions, and offer one level of internal appeal before a final decision (45 CFR 147.136). HealthCare.gov says a claim is a request for coverage, and that you or a health care provider will usually file one to be reimbursed.

If the plan pays less than you expected, or says no

Your Explanation of Benefits shows what the plan allowed and why. CMS defines the allowed amount as the maximum amount a plan will pay for a covered health care service. If your provider is out of network and charges more than the plan's allowed amount, you may have to pay the difference, which is called balance billing (CMS).

  • Internal appeal. For a plan through a job, you have at least 180 days to appeal after a denial (Department of Labor). For a Marketplace or other plan, HealthCare.gov says to file within 180 days of receiving notice that the claim was denied. Use the insurer's forms, or write with your name, claim number and insurance ID number. Your state's Consumer Assistance Program can file an appeal for you (HealthCare.gov).
  • External review. Plans that are not grandfathered under the Affordable Care Act must offer review of denials by an independent party (Department of Labor). It covers, among others, denials that involve medical judgment and denials about the surprise billing protections. HealthCare.gov says to file a written request within 4 months of the denial notice, and a standard review is decided no later than 45 days after the request.

Emergency care and surprise bills

If your health insurance covers emergency care, CMS says the hospital, the providers giving you care at the hospital and an air ambulance can't charge you more for emergency services than the in-network cost-sharing rate, apart from some care after you are stable. Cost sharing is your copayment, deductible or coinsurance. Similar protections cover care from out-of-network providers during a visit to an in-network hospital, hospital outpatient department or ambulatory surgical center, unless you signed a notice and consent form. Ground ambulance is not covered by these federal protections (CMS).

If you got care on or after January 1, 2022, and already paid more than in-network rates for a visit to the emergency room or an in-network facility, CMS says you should submit a complaint. The No Surprises Help Desk, 1-800-985-3059, helps you submit it or find your next steps. A bill before you have met your deductible is not a violation of the No Surprises Act (CMS). Colorado, Maine and New Mexico also set a deadline for the provider to refund you in some of these cases: see patient refund laws by state. Our No Surprises Act guide has the details.

A health savings account or a flexible spending account is a separate route from your insurer. IRS Publication 969 says that when you pay medical expenses your high-deductible plan does not reimburse, you can ask your HSA trustee to send you a distribution. A health FSA reimburses you once you give it a written statement from an independent third party showing the expense and its amount, and a statement that no other health coverage has paid or reimbursed it.

Check the bill before you send it

Before you send a claim, it helps to know the bill adds up and what your share should be. Open it in MedBillCheckup: take a photo or choose the PDF. It is read on your device and the file stays with you. The free check shows how many things are worth asking about, and the largest amount you may get back or may not owe. The full list is paid. With it, we will do the arithmetic and write out what to ask.

Want a second pair of eyes on your bill?

Check it free. Your bill file stays on your device.

Check my bill, free

Questions about this guide

Can I get reimbursed by insurance if I paid out of pocket?

Usually you can send your own claim, and your plan then decides what it covers. HealthCare.gov says you or a health care provider will usually file a claim to be reimbursed for the costs of treatment or services. What the plan pays depends on your plan and the care, for example whether the provider was in your network. Only your plan can decide what it pays.

How long does insurance have to decide on my claim?

For a plan through a private employer, the Department of Labor says a claim filed after the care must be decided within a reasonable time and no later than 30 days after the plan receives it. The plan may extend that once by up to 15 days for reasons beyond its control. For Original Medicare, the claim form says to allow at least 60 days for Medicare to receive and process your request.

Is there a deadline to send my own claim?

For Original Medicare, Medicare.gov says claims must be filed no later than 12 months after the date of service, unless an exception applies. A plan through a job sets its own deadline, and its summary plan description must give its time limits. Check your plan documents or call member services, and send the claim as soon as you can.

Do I need codes on the bill?

Ask the provider for an itemized bill that lists each service with its date and charge. The Medicare form asks for the date and place of service, a description of the illness or injury and of each service, the charge for each, and the provider's name and address. Some insurers also ask for procedure or service codes, if applicable, so an itemized bill with codes, sometimes called a superbill, is the safest thing to send.

My insurer paid the provider after I had paid in full. What now?

Then you may have paid more than your share, and the extra may sit on your account as a credit balance. Ask the provider for a refund in writing. Some states set a deadline for it: see our guide on patient refund laws by state.

Sources

  1. Medicare.gov: Filing a claim
  2. Medicare.gov: Does your provider accept Medicare as full payment?
  3. Centers for Medicare & Medicaid Services: CMS-1490S, Patient's Request for Medical Payment
  4. Centers for Medicare & Medicaid Services: Patient's Request for Medical Payment, form and instructions (PDF)
  5. Legal Information Institute, Cornell Law School: 42 U.S.C. 1395w-4(g)(4), physician submission of claims
  6. Legal Information Institute, Cornell Law School: 42 CFR 424.44, time limits for filing claims
  7. Legal Information Institute, Cornell Law School: 42 CFR 422.568, Medicare Advantage organization determinations
  8. U.S. Department of Labor, Employee Benefits Security Administration: Filing a claim for your health benefits
  9. Legal Information Institute, Cornell Law School: 29 CFR 2560.503-1, claims procedure
  10. Legal Information Institute, Cornell Law School: 29 CFR 2520.102-3, contents of summary plan description
  11. HealthCare.gov: Internal appeals
  12. HealthCare.gov: External review
  13. Legal Information Institute, Cornell Law School: 45 CFR 147.136, internal claims and appeals and external review processes
  14. Centers for Medicare & Medicaid Services: How to read your medical bill
  15. Centers for Medicare & Medicaid Services: Know your medical bill rights when using insurance
  16. Centers for Medicare & Medicaid Services: Dispute a medical bill
  17. Centers for Medicare & Medicaid Services: Submit a provider or insurer complaint
  18. Internal Revenue Service: Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans
  19. Aetna: Medical Benefits, Claim Instructions (an example of an insurer claim form)
  20. UnitedHealthcare: Direct medical reimbursement form (an example of an insurer claim form)

Free tools