| • |
Keep
good records of everything--your coverage, your deductibles, what
you have submitted, and copies of all forms and correspondence. With
the huge amount of paperwork flowing into health insurance companies,
it is not unusual for papers to have to be submitted two and even
three times. |
| • |
Clarify
with your medical provider who is responsible for filing the claim
and make sure they have your current insurance information. |
| • |
Clarify
in advance with your health care provider or the insurance carrier
how much is going to be paid. While not always possible, this precaution
can help avoid surprises later. Usually, your doctor's office will
know how much your insurance company is going to pay and you should
not hesitate to ask them in advance. |
| • |
Ask
your health care provider to submit any planned non-routine procedures
to your carrier and to obtain an "Explanation of Benefits"
(EOB). This is a firm commitment by the carrier as to how much they
will pay. |
| • |
In
the event of a dispute, ask to speak with a supervisor in the insurance
company's claim office. Often the customer service person you speak
with in the beginning has little authority to correct errors or approve
expenses. |
| • |
If
you cannot obtain satisfaction from the supervisor, ask about the
insurance company's "external grievance procedure". Most
health insurance companies maintain a panel of nurses and/or claim
examiners to hear appeals of claim denials. Follow the company's procedures
for appealing an adverse decision. |
| • |
If
the insurance company's external procedure does not resolve the problem,
you may need to contact the appropriate state authority. Many state
health and insurance departments maintain resources for resolving
disputes over health insurance claims. In some cases, these agencies
sponsor their own external grievance boards and their decisions can
be binding on the insurance company. |
Health
Insurance Claim Tips