• 25
  Sep
  2009

• Filing health insurance claims - Part 5

  
  Filed Under:

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.

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