Debunking The Health Insurance Claims Process

By: Tim Gorman
Submitted: 2007-01-17 16:17:23
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Health insurance is no different to most other types of insurance - having the policy is one thing, but what happens if you need to file a claim? There's no one answer to this question. That's because just about every type of health insurance plan has its own method for dealing with claims. Stop for a minute and think about how many health insurance companies there are, then multiply that by the number of policies each company offers, and you start to realize why giving advice on how to file a claim can be so difficult.

This may sound obvious, but if you're not sure how to go about filing a health insurance claim, and even if you’re not sure whether it's covered by your policy, the best thing to do is ring your health insurance company. If you look at their paperwork or website, they will usually have a toll-free number that's staffed during business hours to assist customers. Some bigger companies may even offer extended contact hours. You'll need to have information about your policy on hand, including the policy or group number, and the name of primary person insurance by the policy. Once you've provided those details, the customer service person can look your policy up on their computer and give you specific advice about how to proceed with your claim.

Filing a claim for a covered benefit under a Managed Care Plan is usually quite simple. Quite often the front office staff at the medical facility you visit will take care of the necessary paperwork for you, so you won't need to file a claim. They know all the proper medical codes that apply to the service rendered, and will forward the correct paperwork to your health insurance company. If there's a co-payment required, you pay that at the time of your appointment, so there's nothing else for you to do until you receive the paperwork back from your insurance company. This paperwork will show you what percentage the insurance company paid, what amount was applied to the deductible, and if there is any balance due to be paid by you.

Indemnity Plans used to be quite difficult to deal with when it came to filing a claim. Usually you had to pay for the medical service up front, and then you'd fill out a lengthy claim form and send it to your health insurance company. You would then have to wait anything up to a couple of weeks to receive a reimbursement. Nowadays, it's more common for the front office staff to directly bill the insurance company for the medical service you received. Then, once they find out what percentage of the bill will be paid by the insurance company, they will bill the remainder directly to you. If there's a dispute then the medical services provider will bill you directly, and you are obliged to pay. It's then up to you to contact your health insurance company and sort it out.

Now that computerization is so advanced, the medical billing process is much more streamlined, and generally as a patient your only cost upfront is your co-payment. Even if you need to pay the deductible first, the paperwork goes to the insurance company to determine the correct amounts, so there's a delay before you need to pay. This also means the health insurance company can keep your policy usage and payment history up to date. Considering the sheer volume of paperwork these companies deal with every day, most claims still get settled reasonably quickly.

Article source: Expert Articles