You may have heard stories from family members recounting run-ins with their medical insurance companies that left them feeling exasperated and helpless after a claim was denied. Although they faithfully paid their premiums and did not let their policies lapse, your relatives' claim on the unplanned surgery was not approved. Hours spent talking to insurance representatives, reviewing hospital billing codes and studying the policy coverage ensued. What a nightmare.
You too pay your bills on time and have not let policies lapse, but you are concerned that you will share a similar frustrating experience. You have no medical or legal background, so how can you make certain that your future claims will be approved?
As with many aspects in life, preparing for troublesome circumstances that may appear in the future is vital. Students are required to practice for fire or tornado drills, so they know what to do in the case of an emergency. In a similar way, you should be aware of actions that should be taken if your claim is denied. Think of it as a mental health insurance policy, in that you will be safeguarding your sanity during a stressful situation.
By following these three steps, you can strengthen your claims when you are applying for benefits:
1. Check for accuracy
Yes, those forms that you receive every time you visit your doctor may be tedious to complete in triplicate; however, it is imperative to ensure the accuracy of the information provided on them. Take the time to ascertain that your personal information is correct and current. Also, double check that the data recorded for the insurance carrier and group number is identical to that which appears on your insurance card.
As the warehousing of such records migrates from filing cabinets to computer databases, you may be able to request access to your files through a patient portal. Using this resource, you can review the information you submitted in your doctor's office.
2. Get preapproval for planned procedures
Even if you have a PPO, you may want to check your policy for the protocol that needs to be followed when visiting a specialist or scheduling a surgery. Calling the helpline of your insurance company to make this inquiry may seem like busywork; however, this phone call will help to begin the documentation process so many companies require to approve claims. One call may prevent future frustration if it is determined that extra steps need to be taken before an initial doctor consultation.
3. Review the guidelines of all policies carried
If you carry more than one insurance policy, you should review each to see how best to coordinate the benefits provided. Those who have supplemental insurance in addition to their primary insurance are responsible for understanding which company is first in line to pay the medical bill. Hospital indemnity insurance, a Medigap policy or a prescription drug plan can cover some fees on medical bill but may not qualify as primary insurance. Contacting the helplines of your respective insurance companies can help you determine the best course of action for coordinating benefits. Although you may have sufficient insurance coverage, your claim may be rejected if you list the incorrect policy as your primary policy.
Taking the time to track down the answers to all of these insurance questions may be a time-consuming activity; however, the groundwork that you are establishing now will reduce the time spent chasing down a claim should it be rejected. Peace of mind can be the reward for your diligence.