Preparation Before Filing a Medical/HMO Insurance Claim
Most claims are submitted in writing, not in person or by phone. However in many situations involving PPOs or whenever you have had a choice of a provider you will find yourself in contact with someone from the claims department. Here are the important things you should do before speaking to that person:
- Review your policy and the notes you took and filed from your conversations with the agent or company representative.
- Understand exactly what you have to establish in order to receive the benefits (e.g. that the benefit in question is covered; that the deductible or co-pay is $X; that the treatment was not experimental, cosmetic or something else not covered, etc.)
- If your claim involves a substantial amount of money, run the facts by an attorney.
- Play devil’s advocate, asking yourself what the claims adjuster might say in evaluating the claim.
- Determine any applicable co-pay, deductible or other limitations.
- Make sure your doctor or other provider understands what is, and is not, covered before he/she sends any written letters or reports to the company.
- Cooperate and be polite with company representatives but don’t let them put words in your mouth.
Next: Filing a Claim