There are various types of Medical Healthcare Insurance schemes. It is necessary to find out conditions and clauses in your insurance and plan and check it thoroughly to know everything before purchasing an insurance plan. That is the first step towards maximizing your reimbursement. In this connection you can get all the information form the insurance company or its agent. The more information you know about your policy and your chances are more to maximize your medical claims. There are many options available in the market and you have to choose the exact one appropriate to your specific requirements.
You have to consider all health care insurance plans, doctors, hospitals and other health care providers and who will give you and your family the highest quality services. For the purpose of choosing a service provider, you have to find information to compare your health care choices. This information is available with insurance companies and their agents and this would be prerequisite for you to maximize claims.
More than ever before there are health plans to choose today. Everyone has a choice yet people are not thinking of reimbursement aspect when choosing the health care plan and ultimately problems crop up at the end and in that stage you cannot change anything. You have to understand that it is not the label of the insurance coverage but the characteristics of the plan. It is important to understand your options and how they affect your choice of providers and services, costs, and quality of care.
Your insurance company or the agent or representative should provide a copy of the policy which outlines your benefits, legal rights and Government laws which is prevailing in the country such aspects which protect your health benefits. It should have the information about the coverage of dependents and the circumstances under which you can terminate a health health insurance scheme etc.Keep all other health plan brochures and documents, along with memos or correspondence with the insurance company in a separate file in your custody because they may be required at the time of reimbursement.
There are significant events in anybody’s life that may have changed your health insurance policy.
· Marriage
· Divorce
· Child birth
· Death of Spouse
You or your spouse and dependent children may be eligible for enrollment period under provisions of the Health Insurance policy. With or without life changing events information provided by you in the policy can be changed and in the event changes occur, you must notify immediately to the Insurance Company or otherwise it can adversely affect you at reimbursement process.
It is apparent that rate of insurance is in the rising trend, specifically health insurance rates. Health care industry is deeply influenced by economic inflation. In the same manner cost of living increases and then the cost of medical care too. Insurance companies have no other option but to raise their ongoing rates just to stay afloat in the business. In the point of view of economists inflation to be the number one reason for increasing health insurance rates.
The other reason behind for you to pay a lot more previously than health insurance cost is that your claims. This is a matter for you to consider seriously. The more claims that you are making under your insurance policy, the insurance company need more money to cover you. In the eyes of the insurance company this makes you a liability as any other business and insurance company would like to avoid you.
As a result of you making more claims, it is natural that your insurance company raise the rates on your policy and or reduce the benefits. Therefore, people who need health insurance often will end up struggling financially.
In order to increase their profits, float in the business or guard against bankruptcy insurance companies normally impose larger rates and are more likely to find ways to pay less when a claim is made. For example patients who are suffering from diabetics or asthma will most likely to have higher health risks than those who do not have such sicknesses. In the same manner to the optometrist is not cheap for people who have problems with their eyes. Smoking is likely to bring more health issues so non smokers will have lower risks.
As the information in insurance is changeable, insurance company is verifying patient is eligible every time the services are obtained.
· Reduction of claims and denials due to invalid or inaccurate data
· Verifying medical services coverage
· Information regarding the patient
The only way to guarantee exact payment at the first occasion is submitting an error free claim. A clean claim which is accurately completed in accordance with the insurance companies requirements and billing guidelines and the patient’s data should be accurate to prevent any denial of claims or reduction of claims.
Insurance companies are required to make payment of the claim or provide a denial within a stipulated time period on receipt of an insurance claim. In the event it is not processed within the stipulated dime duration insurance company is subject to penalties.
You have to make sure you are receiving the full insurance claim as per the eligibility under the insurance cover agreed by the insurance company when providing you the insurance policy. Another significant aspect you should be vigilant is on some occasions, you may receive lower reimbursements due to a coding mistake or accounting mistakes by the insurance companies. Inconsistencies, if any, should be addressed to the notice of the insurance company immediately.
You will have to track your medical expenses cautiously since you have to submit bills, receipts, or the explanation of benefit forms from your insurance plan to justify cash payments or charges. It is required to understand up front which expenses are eligible under your policy and which you are not entitled. Your insurance company or agent gives you this information. Many insurance companies also provide this information online. You must spend the total amount you set aside every year or you lose it. Some times as per the policy, balance cannot be carry forward , and you will not be able to utilize the remaining balance at the end of the year. So carefully estimate how much money you are likely to spend on health care each year.
There are certain steps you can take from the beginning to the end of medical care that will help speed the claims process. Answer all questions put forward from your insurance company precisely. Your insurance company can send you a letter asking whether you have other insurance or if an injury was due to a car accident etc. Do not neglect this type of questions and failing to complete forms with correct information can lead to claim denials or reduction of claims.
Insurance companies put a summary of their plans online and print them and read them to understand all the rules. If anything is not clear, call the insurance company and ask what your out-of-pocket expenses will be for the services you want to obtain. It is easier to negotiate beforehand than after a service has been provided. Check whether your insurer requires prior authorization before you undergo any type of treatment. If so, make sure the authorization is obtained before you have the treatment.
Take notes of conversations you have with insurance company and agents. Include the summary of what was said, the date and time of call, and name of the person with whom you spoke. It is necessary that health insurance plans to fully cover many preventive services. Ask your insurer Company or agent which services you are entitled for full coverage and under what conditions.
On the insurance company side you need to understand the process and most claims are submitted electronically and never touch a human eye. It runs through the electronic system and whatever comes out is the outcome.
A variety of mishap and misunderstandings can lead to claim reduction. Missing information in a claim, data-entry mistakes and computer errors also can lead to reductions from health insurance plans. Use last years bills as a guide, if you can. It is always better to underestimate than overestimate. Medical insurance claim mistakes can happen for reasons beyond your control due to miscommunications between insurance agents and insurance companies.
Cheapest insurance plan is not the best insurance plan available in the market. Consider your and your family medical expenses during the past years. How much you have spend on preventive care, baby care, vision, dental care etc and calculate roughly the expenses caused and when you answer your own questions it will help you to determine the expenses you need to reimburse from the insurance company under your policy in the next year. Matching your requirements and those of family members of yours will be able to find out best possible insurance policy. Your primary objective should be to obtain the high quality health care and reimburse maximum medical insurance claim.