Help With Health Insurance Claims

Your Policy

Read your insurance policy claims section to help familiarize yourself with the procedure you face when you need to make a claim. Usually this will be a few pages long. Make sure to pay attention to time limits given for a claim, to whom you make the claim, and if there is a section dedicated to claim refusal. If you see any section that you feel may be useful in the future, highlight it for future reference. It is important to check whether your insurance company will process the claim before or after you receive the procedure you require. If you have one of these plans, whenever you receive a procedure you will also receive an explanation of benefits (EOB) with your bill. Have a look at what was covered and what was not covered to ensure you have fully understood how well you are insured. If anything is wrong, do not hesitate to make an appeal.

Claim Denial

If your claim is denied, look through your insurance handbook and pick out the points you believe support your claim. Call your insurance company immediately and ask why the claim was denied. Always take notes, including the time you called, the date and the full name of whom you spoke to. Ask at this time about the appeal procedure for insurance claims. After speaking to your customer representative on the phone take down notes from the insurance manual supporting your claim. Keeping thorough records will ensure that you are not caught later missing a small detail, and proves the work you have done.

Outlook

Many insurance claim denials are due to clerical error, so with a call to the insurance company you will usually be able to clear things up. If it is not you can request an itemized bill for the procedure you received. If there are any charges on the bill for services that were never performed or delivered, you should make your insurance company aware of them immediately. Often, these are the small items that cause a claim to be denied. If the problem continues, you are within your rights to claim a formal review of the procedure you received. Again, time is of the essence; many insurance companies have a time limit on how long you have to make your insurance claim, and a time limit to appeal denials. Health insurance, no matter who the provider, tends to be a service full of paradoxes and difficult claims. Knowing how to claim properly as well as what your rights are when you are denied an insurance claim can be a steep learning curve. Knowing the basics can help you make educated decisions when making a claim.