health-insurance-claim-filing-tips
Health Insurance Claim Filing Tips - Understanding tips
useful filing medical claims to prevent unnecessary hassles and increase your
chances of getting a replacement. Here are the things you need to do when the
health claim
Read Certificate /
your insurance policy.Before undergoing treatment at the hospital, learned all
the provisions of the policy benefits. If you are a collection of health
insurance, you are usually given a list of benefits of the policy. You can also
ask the personnel to know the limits of the policy benefits according to the
parent company. For your individual policy holder, you can ask the agency and
the services your insurance claim.The things you need to know from your policy
certificate as:
Health insurance
benefits are paid, the maximum limit for each item of treatment and rest limits
you have.
Exceptions, the type
of disease or treatment is excluded methods, such as: congenital disorders,
cosmetic surgery, disease existing before the policy is effective (pre-existing
disease), etc..
Claims procedures,
including how well the types of documents must be completed. If your insurance
company provides superior partner (provider), you have to know which hospital
in your town who are the partners. The benefits of treatment in hospital
partner is you do not need to spend money on insurance and pay the cost of care
in advance.
Learn carefully hospital bills.At the time of leaving the
hospital, the hospital will ask you to sign the details of maintenance costs
will be billed to the insurance company or to you. Make sure that the data is
comprehensive care, including diagnosis, type of action, the cost for each
item, the date of treatment, doctor's name and data policy relevant. Little
mistake in the writing of the name, for instance, could result in delays in the
payment of your claim.Pay attention to word choice in the diagnosis. Handling
the same but with a different diagnosis can get approval different claim. For
example, if the diagnosis suggests that the disorder is congenital (inborn)
although the trigger is a new disease, your claim may not be paid. Similarly
with dental rehabilitation operations or parts of the face that are considered
cosmetic. When you see there is a "gray area" in your policy, talk
with the hospital and insurance to intrepretasinya not harm you.
Ask a claim file
as soon as possible.For insurance reimbursement (reimbursement) without going
through the provider, the claim must be filed after the completion of
treatment. Insurance companies generally have a claim period expired. If it
passes that date, your claim may not be paid. In addition, the submission also
allows insurance faster to communicate with the hospital because the
information is still fresh. Even more importantly, the sooner filed, the sooner
you will get your money back!
Copies of papers
filed claims.You never know how good the quality of the administration of your
insurance company. If for some reason you lose your files, you'll be grateful
to have a copy.
Do not immediately
accept the claim denial.If you receive a rejection letter, learn why, compared
with provisions of the certificate / policy. As far as the refusal is not
because of something that was clearly stated in the policy, you are entitled to
file a complaint. Say "defense" you orally or in writing to the
insurer. In many cases, insurance companies are willing to budge or give
partial compensation. In fact, almost every company there's always insurance
claims payments that are ex-gratia, the payment of claims that are not
guaranteed in the policy. Ex-gratia payments are usually based on customer
service and business considerations (sustainability policy).
