A claim is the bill submitted to your health plan asking it to pay for a service you received. Providers usually file claims for you, and the plan responds by paying, reducing, or denying them. The plan's decision is documented on an explanation of benefits, which is where you first see whether a claim was denied.
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Disclaimer: This definition is provided for general educational purposes only and is not legal, medical, or insurance advice. Insurance rules, deadlines, and terminology vary by plan, state, and over time. Always check your own plan documents and confirm current details before acting.