What does the term "claim" refer to in health insurance?

In health insurance terminology, a "claim" specifically refers to a request for payment for healthcare services that have been provided. When a healthcare provider delivers medical services to a patient, they will submit a claim to the insurance company to seek reimbursement for those services. This process is essential as it helps facilitate the financial transaction between healthcare providers and insurers, ensuring that providers are compensated for their work while also providing a mechanism for patients to receive the necessary care without immediate payment out of pocket.

Understanding this term is crucial for navigating the healthcare system, as it underscores the relationship between patients, providers, and insurers. The claims process also involves verification of covered services, treatment necessity, and compliance with insurance policy terms, making it a fundamental element of health insurance operations.