When a health insurance company is deciding whether to pay for someone’s medical treatment, the insurer generates a file around the claim. All associated records, from audio of internal phone calls to notes about cost-cutting programs, should be part of the file.
Patients have a right to see their file. The information provides a unique window into the system and can help people craft better appeals.
In May 2023, ProPublica, a nonprofit investigative news organization, published an article explaining the process for requesting a file. We believe all patients deserve this information. We also created a space where people could share their claim files with our journalists in order to crowdsource important stories about this opaque industry.
In the following months, many health care providers and patients reached out asking how they could help get word out. So, ProPublica created a claim file request kit designed to be shared with communities. Some health care providers have told us they plan to place these in their waiting rooms, while patients have expressed interest in placing them on bulletin boards in community centers where they attend support groups. The kit includes:
- 10 pamphlets that synthesize the process for submitting a claim request.
- Five double-sided claim file request templates.
- Details about where to find more information.
Interested in receiving a kit? Sign up below.