Medical Insurance Invoice Template

Medical Insurance Invoice Template can be used to invoice Insurance Clients for the care of a concerned Patient or for an expected payment due to a contract. This document’s goal will be to aid your efforts to organize the information that must present to receive payment so that it can be displayed for the Recipient’s review. It is worth mentioning that while this document delivers a versatile framework, the privacy laws regarding such paperwork in your state should be reviewed before attempting to completing this document. It will be up to the billing Insurance Company to be fully abreast of its reporting obligations.

Average Cost of Individual Health Insurance (2020)

National Average (Monthly cost/Annual cost): $403.36/$4,840.33

Source: ValuePenguin.

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How to Write in PDF and MS Word

Download: Adobe PDF & Microsoft Word (.docx)

1 – Obtain The Medical Insurance Invoice

Download the “Adobe PDF” or “Word” version of this invoice through the text links and file buttons designated with these file types. Make your selection using your mouse.

2 – Identify The Medical Insurance Company

Name the Medical Insurance Company using the first field of this page. Input this entity’s full legal name in this field.        The Medical Insurance Representative sending this invoice to the Client should self-identify on the first labeled line (designated with the text label “Name”).    Produce the mailing address for the Medical Insurance Company on the lies labeled with “Street Address” and “City, State, Country.” This address presentation will require that you report the “ZIP Code” on the next line (separately).      Use the next two lines to document the Medical Insurance Company telephone line and email address on the last two available lines.   

3 – Invoice The Client For The Patient’s Care

The invoice number the Medical Insurance Company intends to use for this document should also be available for the Patient’s use and the Client’s use. Input it on the “Invoice #” line and record the appropriate invoice “Date” on the next blank space.    Details required to identify the Patient must be produced in the “Patient Information” section. This will help the Recipient identify the source of this bill. Three blank lines will be sufficient for this task. Fill in the Patient’s “Name,” “Age,” and “Gender” on the empty lines where requested.        Directly address the Medical Insurance Client in the “Bill To” section by submitting the complete “Name” of this party to the properly designated empty line.          Underneath the Medical Insurance Client’s identity, make a submission of the mailing address where this entity can be reached. That is, where this paperwork is being sent.        The final piece of information requested is the “Phone/Email” line. This should be used to either furnish the Client’s telephone number or e-mail address to this section. You can also present both items (ideally).             

4 – The Medical Procedures Being Billed Must Be Detailed

The medical insurance table in the middle of this page contains two columns. The “Medical Procedure” box on the left will give ample space that you can use to present an account of the treatment being billed.      The “Amount” box on the right is reserved for the cost of the concerned medical treatment(s). Report this information to available space under this heading.           All costs should be added to one total in the “Subtotal” box while the “Tax” should be listed separately in the next box.               The last box in this column will be labeled “Total” and refers to the sum of the “Subtotal” figure and the “Tax” amount you reported.           The sentence under the table you filled out, presents an empty space that you should fill in with the number of “…Days” the Medical Insurance Company will wait for payment before classifying it as late.              The last item on this page that will accept information is the “Comments Or Special Instructions” section. The blank lines in this section remain at your disposal should you wish to produce additional information to this paperwork or cite an attachment.             

How to Write in MS Excel

Download: Microsoft Excel (.xlsx)

1 – The Medical Insurance Invoice Is A Downloadable Spreadsheet

When it is time to invoice the Medical Insurance Client, obtain the spreadsheet invoice on this page. Access the Medical Insurance Invoice by selecting the link “Microsoft Excel (.xlsx).” Another option for attaining this spreadsheet is the “Excel” button on this page.

2 – Submit The Medical Insurance Company’s Legal Contact Information

The Medical Insurance Company’s banner or its logo should be attached to cell A1.  Additionally, produce the legal name of the Medical Insurance Company in cell A2.          Cells A3 through A6 will satisfy two requirements for this document. First, in cell A3, the full “Name” of the Medical Insurance Representative responsible for this handling this document and any Client inquiries must be presented. The second piece of information this portion of column A deals with is the mailing address the Client will be expected to use when contacting the Medical Insurance Company and/or submitting payment by mail. The Medical Insurance “Street Address” (Cell A4) and its “City, State, Country” (cell A5) along with the Medical Insurance Company’s “Zip Code.”        In addition to the Medical Insurance Company mailing address, produce its email address in place of the text label “E-Mail” (located in cell A7).      The final requirement of this column is the Medical Insurance Company’s “Phone” number. Type it into cell A8.       

3 – Produce Material Defining This Paperwork For The Medical Insurance Client

Directly across the invoice from the Medical Insurance Company is a small two-column table where the invoice number and the invoice “Date” used by the Medical Insurance Company for this paperwork. Produce the determined invoice number in cell F4 and the accompanying invoice “Date” in cell H4.      The two columns in the next segment of this invoice will be labeled as “Patient Information” and “Bill To” section. These sections will identify the two parties directly involved with the care or treatments being billed. The first of these parties would have received them while the second is obligated to pay for them. The first Patient Information section includes a few cells (A11 through A13) where you must enter the Patient’s “Name” then his or her “Age” and “Gender.”

The entity responsible to pay for the Patient’s treatment must be called out in cell E11 by substituting the text label “Name” with the entire legal identity of the Payer.     The text labels in cell E12, E13, and E14 act as a guide for you to record the Medical Insurance Client’s “Street Address” (A12), the corresponding “City, State, Country,” as well as the Client’s “Zip Code”   Cell E15 is devoted to solidifying the Medical Insurance Client’s identity with that entity’s telephone number or e-mail address. Ideally, you should present both of these items.     

4 – Make A Production Of The Medical Treatment Charges

The medical insurance table occupying the majority of the next section of this sheet requires only two columns of information. Notice that one of these columns contains multiple cells. Cell A18 is the first part of this table that will require material supplied to it. Locate the Patient’s records then list the medical treatments or medical care that requires payment. Remember to observe the privacy laws in your state.      Column H will contain multiple cells that need your input. First, inform the Medical Insurance Client of the base charges required for the provided care in cell H18. You will also need to sum these charges to one total in cell H19 (“Subtotal”) and list the “Tax” as a separate amount in cell H20.       Cell H21 will represent the full dollar amount that must be paid by the Medical Insurance Client and should be entered as the sum of the past two cells (H19 and H20).       Now in cell A22, an obligatory statement is made on the Medical Insurance Client. Substitute the number making up the amount of “…Days” that the Medical Insurance Company will allow as a grace period for the bracketed symbol in the statement provided.            If more material pertaining to the Medical Insurance Client or the invoice we just completed, it may be supplied to the available space in cell A23.