Understanding The Health Insurance Claims Process2 min read
It is very important to make sure that you have adequate health insurance but you also need to make sure that you know how to make a claim when the need arises. The health insurance claims process is fairly straightforward but you need to make sure that you have all of the information that the company will need so that your claim is processed as quickly and efficiently as possible.
Many people assume that the hospital and insurance company will do it all for you. Unfortunately, if you do this and do not make sure that it is being processed correctly then it might be that they will process you claim in a way that suits them and that you will not get all of the benefits that you are rightly entitled to.
A lot of health insurance policies will have coverage for a lot of conditions that are pre-approved, so it is important to read your policy carefully to see if the condition that you need to make a claim for is actually pre-approved as this will save you a lot of needless work. If you are not sure, then it is a good idea to call the insurance company providing your coverage and ask them as they would rather spend a few minutes helping you on the phone than having to work through a lot of pointless paperwork that you have given then for a condition that is actually pre-approved for treatment.
You also need to make sure you have read the schedule that tells you what benefits are attached to your insurance so that you know what you are entitled to. Additionally, you also need to read the exclusions and the limits for your insurance. There will be a separate part that tells you how to submit your request as each company has it’s own way of processing claims. If your insurance is an indemnity plan then the company will only process the claim after you have had the treatment, but you should always get an explanation of benefits whenever any part of a claim is processed no matter what insurance plan you have, this way you will know exactly what they have allowed or disallowed and why.
When you make an insurance claim it is important to make sure that you are fully aware of what that hospital and insurance company are doing so that you can make sure that they are giving you everything that you are entitled to that way if there is anything that needs sorting out you can give them the information to do it as soon as possible.