Filing A Health Insurance Claim

Just having health insurance can give you the feeling of having a safety net. But what happens when it comes time to file a health insurance claim?

Because every type of health insurance plan has its own way of handling claims, there is no single answer to this question. When you consider the number of companies offering multiple types of health insurance policies, you begin to understand why the subject of filing a first claim becomes so complex.

Begin With The Help Desk

If you need help understanding how to file a claim for a benefit that is covered under your health insurance policy, the best place to begin is with the insurance company itself. Most companies offer a toll-free telephone number that is staffed during normal business hours.

First, you'll typically be asked for basic information about your policy, including the policy or group number, and the name of the primary insured on the policy. From there, the insurance company representative can access the details of your health insurance policy and advise you how to proceed with your claim.

For Managed Care Plans

If you have a Managed Care Plan and you're dealing with a covered benefit, you'll find the process surprisingly simple. Most often, the people who staff the front offices of the medical facilities handle the processing of the necessary paperwork. They input the proper medical codes for the services rendered, and send the paperwork to the insurance company.

Patients typically make the required co-payment at the time services are rendered, and need take no further action until they receive paperwork from the insurance company. The paperwork shows the percentage paid by the insurance company, how much was applied towards the deductible, and how much, if any, balance is due from the patient.

For Indemnity Plans

In the past, those with Indemnity Plans were required to pay in full for the services at the time they were rendered. They were given lengthy claims forms to complete and submit to the health insurance company. It would take weeks to get reimbursed for the services provided.

But today, medical front office personnel usually will directly bill the insurance company first, and then they'll wait to see what percentage the company pays. If there is a balance due afterwards, they will bill the patient. Anytime there's a dispute, the medical services provider will bill the patient directly, and the patient must pay. It's then the patient's responsibility to work out an agreement with his or her health insurance company.

Benefits Of Computerization

With the speed and efficiency that computerization has brought to the medical billing process today, patients rarely have any out-of-pocket costs aside from their co-payment. If they are required to first meet their deductible, the paperwork still gets forwarded to the insurance company first, so they can keep accurate track of the policy's usage and payment history.

Considering the enormity of the task, most health insurance claims for covered benefits today get settled with very little trouble.