While it is true that no one can predict an emergency situation requiring urgent medical assistance, anyone who maintains medical insurance should be well aware of what his, or her insurance policy does, and does not cover. Having a medical claim denied by an insurance provider during a critical time is something no one should be forced to endure, especially when it takes precious time away from caring for yourself, or a loved one.
Insurance companies pay armies of investigators millions of dollars annually to research and discover not only fraud, but also to uncover any irregularities in medical claims which, once discovered, allows the insurer to disqualify the claim; leaving the dismayed policyholder to pay most, if not all, of their medical expenses.
Take note of these important recommendations that any insurance consumer can perform on their own prior to receiving non-emergency medical treatment to avoid the possibility of having a claim denied. A few minutes of research and verification on your behave could potentially save you thousands of dollars, and a world of headaches.
Verify Your Insurance Benefits
One thing you can check before making an appointment to receive medical care for yourself, or a loved one, is whether, or not the person is covered by the insurance policy at the time of service. Policies sometimes lapse, or take time to go into effect when someone is added at a later date. So, just taking a few minutes to verify that the insured is actually covered during the time of service is very important if you plan to file a claim to cover expenses.
Another safeguard the insured can take to protect themselves from denied claims is to make sure beforehand that the services being provided do not require pre-authorization from their insurance provider. Do not assume that your insurance provider covers all of the services and procedures you will undergo automatically. Some procedures, and drugs require pre-authorization in order for the policy to cover the expenses.
Finally, you should also prepare for your doctors visit by fully understanding what your responsibilities will be in the way of co-pays, and deductibles. Often insurance companies may cover only part of the payment for some services leaving he insured to pay the balance. Don’t get caught off guard by unexpected medical bills that you thought were be covered by your insurance.
By taking the time before you require medical services to study, and understand your policy, and by paying close attention to communications from your provider regarding changes in your coverage, you should be able to avoid surprise charges, and claims denials when you need medical assistance. This will leave you free to focus on more important things in life, like being healthy.