Illness and bodily harm can often happen out of nowhere. Sometimes, these ailments can unfortunately land you in the hospital. However, sometimes paying medical bills can seem more painful than the actual illness. Filing an insurance claim can be a complex issue because after all, most people rarely have to do it. The following list includes some of the most important things to keep in mind the next time you’re getting ready to file for reimbursement.
What You Need
When you first receive your insurance claim form, it can be a little daunting. The good news is that if you really take it step by step, you will notice that most of the information being requested is self-explanatory. The information requested depends on your state, although most insurance companies tend to ask for the same type of information. This includes your insurance policy number or (member number) if the person checked into the hospital was not the primary user but a dependent such as your child. Other detailed information they will require is the information surrounding the cause and the location of your accident. This may include if your visit was something you did on your own or part of workers’ compensation. Therefore, you will need to have proof from your employer on hand.
Confirm Your Diagnosis
If there is one way to make the insurance claim process more difficult for you, it is to get only one opinion and place that diagnosis on your paperwork. Insurance companies like certainty and may not want to pay you back if your information is found to be inaccurate. Therefore, the best route to take is to get a second or even third opinion in order to confirm your diagnosis. Over 10 million Americans are affected by misdiagnosis which is likely correlated with the resistance to getting a second opinion, considering just under half of patients even seek a second opinion.
Make Sure Your Claim Is Valid
One of the most common misconceptions is that once you send out your claim, then it is automatically paid for. This, however, is not the case. An insurance claim is simply a bill sent out to your insurance company by yourself or your health provider. This is why it is so important to have open communication with your insurance company regarding your specific benefits and coverage. Never be afraid to ask questions or voice any concerns you may have.
What happens if your insurance claim is denied? The good news is that this isn’t the final decision. According to the Affordable Care Act, you have the right to appeal that denial and have your claim reviewed. Your insurance company will have to provide you with information regarding the reasons why your claim was denied. If by any chance, they don’t do this, you can then request a review of your claim by a third-party. This is a difficult and tedious process, but the fight is worth it.
Filing an insurance claim can be a challenging and daunting experience for most. After all, nobody wants to get stuck with the bill after they’ve been paying their insurance companies for years. Therefore, it is incredibly important to collect all your documents and have a detailed account of your accident. You may even bring in an expert, such as an ELP, to provide you with additional guidance.