• 30
  Sep
  2009

• Filing health insurance claims - Part 8

  
  Filed Under: Health Insurance
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This is a rare occurrence, but sometimes you might be required to file your health insurance claim yourself. That is, the doctor's clinic will not make the claim on your behalf.

What seemed like a simple procedure all these days, might suddenly seem very difficult to manage yourself. Given the busy schedule that international students face in universities, it is better to know the procedure beforehand to save a lot of time, and avoid the possibilities of errors. Here are a few steps that need to be followed to file your health insurance claim yourself:

1. Get an itemized bill for every service received at the health care center.


2. Get the claims form. In most cases it can be easily collected from the insurer's office, or sometimes downloaded from their website (and printed out).


3. Fill out the claims form with details like doctor's name and address, reason of seeking health care (flu, accident), etc.


4. Attach all the bills in original.


5. Make a photocopy of each and every document you are submitting. It will be much easier to follow up if some clarifications are sought.


6. Call the insurer's office. Review with them if the documents you are sending are adequate.


7. Send the documents to the insurer's address, and wait for the payment to be settled.

That's it. It is actually that simple to file your health insurance claim yourself.

Also, this post wraps up our filing health insurance claims series

• 29
  Sep
  2009

• Filing health insurance claims - Part 7

  
  Filed Under: Health Insurance
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Getting a denied claim after making a (seemingly) valid health insurance claim can be quite a nightmare. If the insurance company doesn't pay, the debt is on you. As an international student studying in the USA, medical emergencies might not always be factored into your study budget. But, not paying might affect your credit worthiness. So, what do we do now? Is everything lost?

Thankfully, no. A denied claim is not the end of the world. There are ways to still get it reversed. Here are some tips to proceed in this scenario.

1. Many times, a denied claim is nothing more than an administrative error. A simple phone call to the insurer's help desk can fix more that you would believe.


2. If you feel the insurer is being unfair in denying a claim and you are authorized to receive the payment, try calling the help desk again. If they do not respond properly, there are government offices in every state in the US to facilitate and regulate insurance claims. File a complaint and another expert will look into the issue and try to find a solution.

Usually, if you appeal, some more documents will be requested, the issue will be looked into once more, and there is actually a chance the claim might go through. It might take longer, but isn't it better than nothing?

• 28
  Sep
  2009

• Filing health insurance claims - Part 6

  
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This is a continuation from previous posts where we talked about the health insurance claims process, some jargon was clarified and a few basic concepts were cleared. Let us look at some not so smooth sailing. We mean specifically a situation when the insurance company replies with a denied claim. Though it is not that common, it does happen once in a while. Here are a few ways to avoid such a scenario.

1. Be completely truthful when applying for a health insurance policy. Not declaring pre-existing conditions is a major reason for denied claims.


2. Be fully aware of each and every clause of the policy. That means you will have to read the fine print (as boring as it might seem) and in case you have some doubt, get it clarified. The insurer is legally bound to explain everything clearly to you.


3. Whenever you go to the doctor for something that seems even a little out of the ordinary, it is best to call the help desk and clarify if the event will be covered.

In spite of taking these precautions, if you do end up getting a denial, it doesn't mean nothing more can be done. You can definitely appeal, furnish more documentary evidence and seek a review. We will see how it can be done in a subsequent article.

• 25
  Sep
  2009

• Filing health insurance claims - Part 5

  
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In our previous posts ( Part 1, Part 2, Part 3, and Part 4 ) we saw some basics that one needs to know before filing a health insurance claim. Let us now see how a claim form processed in a clinic by a receptionist gets converted into payment for the doctor.

The steps involved in a typical claims process are as below.

1. You call the doctor and get an appointment


2. You reach the clinic and fill a form with your details


3. You show your health insurance card, and someone at the reception makes a note of it


4. In case of a doubt, the insurance office is called and a confirmation is sought whether the treatment is covered under the policy


5. You receive medical care, pay your share of the bill (deductible) and leave


6. Your claim form along with the patient information sheet, intake form, etc. are sent to a health insurance processing center


7. These are compared with the insurer's record to see if you are eligible for the entire coverage sought


8. If yes, the remaining payment is made to the clinic


9. If no... well, we move into muddy waters, which usually means partial payments or denied claims

Usually, the claims process is very smooth. Let us look at what happens when there are some bumps along the way, in a further post.