Once you have filed for a claim, and it has been rejected, it is important to understand the reason behind the rejection. It could be possible that your insurance information may have been inaccurate or incomplete. It could happen that there was no prior authorization, or pre-certificate for the particular procedure. There might have been an error during the diagnosis or the procedure, which is another reason for rejection of the claim. Filing for claims after the given time period is one of the most common reasons why claims are rejected.
If you are unfortunate and have your claim rejected, the next thing to do is get the help of advocates. There are several hospitals that enlist the help of social workers who help the patients deal with health care insurance companies. These social workers will help you capture all kinds of benefits that you can use to pay your bills. Having these look over your paperwork before you submit, it is definitely a feather in your cap. It is also a smart idea to have doctors on your side as well. They will be able to clarify or correct your claim submission.
In today’s technological world, different kinds of software are used during auditing. The software program used by medical insurance companies especially sifts through the numerous claims received by them. The software attempts to reduce the amount of money that has to be paid out to doctors and physicians. However, if you apply, and then continuously re-apply for your claim, you have higher chances of your claim finally being approved.
Important points to keep in mind are:-
1. Always have all your documents filed electronically and keep all your records in place. This way, there will be a digital paper trail between you, your insurer, and either your doctor or social worker. Even if you use postal mail, remember to keep copies of all the letters and papers. This way, the company cannot refuse your claim for health insurance because you have been ignorant of disorganized.
2. It is always important that you know just how much your procedure cost, and how much your health plan will cover. Once you have these figures, it becomes easier to negotiate with the company as to who can pay how much. This way, the insurance can pay a certain amount, and you can pay a small amount, reducing the financial burden for both. To avoid a situation like this, it is best to check the terms and conditions of your health insurance before filing for claims.