Health Insurance - Going Through a Claims Procedure

By Compuquotes Team on March 27th, 2008
Health Insurance

More people stress more about the claims procedure and their health insurance company then the actual physical issue that put the in the hospital or other medical facility. There are thousands of different health insurance companies and every single one has its own set rules for filing a claim. This can make things more confusing in a time when you need for things need to go as smoothly as possible.

There are many people who are confused at what you are supposed to do when you need to file a claim for benefits that are covered in your health insurance policy. If you are confused the first thing you should do is call your insurance company. Every insurance company will provide you with a toll-free phone number for any claims. This toll free number usually has agents working normal business hours. Have your basic information about your policy such as the policy number and the name of the main person insured ready before calling because this information will ensure you a quicker claims process.

However if you have a Managed Care Plan and are claiming something that is obviously covered, then you will likely find that the process is incredibly easy for you. The front desk staff of the medical facility will generally process the paperwork that is needed as part of their job. They can easily put in the medical codes for treatment and services they provided you with and send it to your insurance company. If your insurance requires a co-payment then this is usually paid at the time of treatment so that you won't need to take any other action until your health insurance company sends you documentation regarding your treatments.

Holders of Indemnity plans used to be forced to pay in full for any treatments that were provided to them. Then they were given long claim forms to fill out and return to their health insurance company for reimbursement. This process usually took several weeks to get a response or their money back.

Now medical facilities bill the health insurance company then wait to see what percentage the company must pay. The remaining balance, if any is paid by the patient.

If there is a dispute the medical services provider bills the patient. The patient then must seek reimbursement from the health insurance company if they want the money back. It is solely their responsibility to take action, the insurance company is not going to come knocking your door down trying to give you money.

Technology has advanced and the computerized medical billing processes most patients don't have to pay any upfront costs, other than the co-payment. Even if patients are required to first pay their deductible the paperwork is still forwarded to the health insurance company so that there can be an accurate record of the policy's usage and payment history.

Most insurance companies recognize the gigantic financial burden that is involved in medical treatment. Companies generally settle these claims very quickly.

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