Health Insurance - Understanding The Claims Procedure

Having got your health insurance policy you would think that things would be fairly straightforward when it comes to making a claim. Unfortunately, that's not always the case. There are a large number of companies selling health insurance today and each one will have its own set of rules when it comes to making a claim. Indeed, even within individual companies the procedure for making a claim can vary across different types of health insurance policy.

If you're not sure what to do when it comes to filing a claim for a benefit that is covered under your health insurance policy, then your first port of call should be the company itself. Most insurance companies will offer a toll-free telephone number for claims which is staffed during normal office hours. Normally you will be required to provide some basic information about your policy, such as the policy number and the name of the principal person insured under the policy. With this, the insurance company representative will be able to access details of your policy and advise you how best to proceed with your claim.

If you have a Managed Care Plan, and you are dealing with something that is clearly covered by the plan, then you should find that the process is very simple. More often than not, the staff at the front desk of the medical facility where you receive your treatment will process the necessary paperwork for you. They will input the necessary medical codes for the treatment and services provided and then send the paperwork directly to the insurance company. If a co-payment is required this will typically be paid at the time that treatment is received and you do not need to take any further action until you receive paperwork from the insurance company which corresponds to your treatment. This paperwork will show the percentage paid by the insurance company, how much was applied towards the deductible and whether there is any balance due from you.

Until recently holders of Indemnity Plans were required to pay in full for any treatment provided at the time of treatment. They were then given lengthy claims forms which had to be completed and submitted to the health insurance company for reimbursement. It would then typically take several weeks before reimbursement was made.

Today, it is common for the medical facilities at which treatment is carried out to bill the health insurance company directly and then wait to see what percentage the insurance company pays. If there is any balance due the medical facility will then bill the patient.

In the event of a dispute the medical services provider will bill the patient directly and, in these cases, the patient will need to pay. It then becomes the patient's responsibility to seek any reimbursement from the health insurance company.

With modern computerized medical billing processes patients today do not normally have any out-of-pocket expenses apart from any co-payment. If patients are required to first meet their deductible the paperwork is still normally forwarded to the insurance company so that an accurate record can be maintained of the policy's usage and payment history.

Because of the sheer enormity of the cost and the sums of money involved, claims today are normally settled very quickly.

Not only do claims procedures vary between insurance companies but policies also vary widely between states. California health insurance for example will not have the same requirements as Florida health insurance. If you are looking for good low cost health insurance then there is no better place to begin your search than right here online.