Understanding the Medical Insurance Review Process - The Five Key Steps in Medical Insurance Review
When you have a medical insurance claim to make, the medical review process is a confusing one. Fortunately, it's actually not as complicated as it may seem at first glance. Understanding the five key steps in this process can help take some of the stress out of making any new claims and maybe even save you some money.
For those without coverage, it's worth understanding that this is also an important section of the healthcare system; for those with coverage, here are five key steps that will help make your next claim less painful:
1. You need to file a complete claim form with your insurer and cover them so they can determine if they will pay for any costs associated with your health care treatment.
2. You need to get an authorization for treatment form from your doctor and the hospital where you were treated for treatment of your condition. In some rare situations, you may need to get authorization from your treating physician , as well as the insurance company. If this is the case, make sure you speak with your health care provider about getting this form signed in a timely manner and by multiple people.
3. You'll need to submit all of the paperwork related to your claim: medical records, bills, receipts for any medical services and medications, etc. All these items will be reviewed by an insurance company compliance group who will decide whether or not they should be reimbursed for any claims submitted.
4. If your claim was denied, you have three options: pay the denied amount within a certain timeframe or file suit with your state's attorney general's office or the small claims court, or you can appeal to the insurance company.
5. You have a final option: file a complaint with the US Department of Health and Human Services (HHS) Office of Civil Rights (OCR) and/or state insurance fraud investigators if an agency has received complaints about your claim being mishandled by your insurer.
And there you have it, five key steps that can help make the medical review process less confusing and painful for everyone involved – both those with coverage and those without.
What's the right one for your situation? It could depend on the type of coverage you have, whether or not you have any insurance coverage at all, and how much effort you're willing to put into making a successful claim. It may be different than what I've written here, and part of getting an actual medical insurance review is a lot of research as well as being able to read your policy information carefully.
Written By: Scott Culp - president of Healthcare Advantage For You LLC http://www.healthcareadvantageforyoullc.com/ - (888) 772-6434 scott@healthcareadvantageforyoullc.com
Good luck in your claims! http://www.healthcareadvantageforyoullc.com/
We are not your average medical insurance service company as we provide a personalized and professional client service approach rather than the "blend-and-bake" approach of larger competitors. http://www.healthcareadvantageforyoullc.com/
Health Care Advantage For You LLC is an independently owned and operated medical insurance consulting business that provides medical insurance coverage analysis for both individuals and families looking for Health Insurance coverage in addition to providing Medicare plans and supplemental health care services including HMOs, PPOs, Medicaid plans as well as Medicare supplements available through our independent network of HMOs and other health care plans.
We are not your average medical insurance consulting service as we offer a personalized and professional client service approach rather than the "blend-and-bake" approach of larger competitors. http://www.healthcareadvantageforyoullc.com
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Health Insurance Information What is Health Insurance? : http://www.youtube.com/watch?v=hETG6-x5X_c&feature=related Health Insurance Information Principles of Insurance: http://www.youtube.com/watch?v=_Nw96LzhkzE&feature=related
Health Insurance Information How to Choose a health insurance plan: http://www.youtube.com/watch?v=AuHo8frTfZM&feature=related
Health Insurance Information The Health Insurance Portability and Accountability Act (HIPAA): http://www.youtube.com/watch?v=lNXxn-_HbFQ&feature=related
Health Insurance Information The Korean National Health Insurance Service: http://www.youtube.com/watch?v=Kpt5qyD0Z1c&feature=related
Health Insurance Information Auto-Owners Benefits: Your Life, Your Choices: http://www.youtube.
Conclusion
If you are eligible for Medicaid, it may be in your best interest to apply for Medicaid as your state's insurance carrier typically won't provide coverage at 100 percent of the amount they would have paid if you had purchased individual insurance rather than Medicaid.
On the other hand, if you do not have affordable health insurance coverage because you can't afford to pay an additional premium, then you should apply for insurance coverage through your state's health exchange. Even though this process is a little more complicated, it may be the only affordable option available for you and your family to receive affordable health care coverage..