Nobody Ever Said Dealing With Insurance Companies Was Always Easy. Occasionally There Can Be Unforeseen Delays, Policy Misunderstandings, And Special Circumstances That Can Make Communication With Them A Frustrating Ordeal.
Healthcare claim denial, or the refusal to honor a claim by one's insurance company, is a more than common occurrence within the United States, but it does not need to be.
According to a study done in 2010 by the US Government Accountability Office and the Department of Health and Human Services, the claim denial rate on filed medical insurance claims for the first quarter of 2010 was nineteen percent.
This is a shockingly high number of claim denials when one considers that it equals just fewer than one in five claims that are being denied; that is nearly one in five people who are stuck paying for the costly medical claims by themselves out of their own pockets.
7. Poor bedside manner. They may not teach bedside manner in medical school, but it is crucial in the medical field. Patients do not feel like they can trust their doctors if they can't make eye contact, continuously look at the clock, or interrupt them.
Knowing Your Legal Rights As A Client Of Your Insurance Company Can Help You Know What You Have The Power To Demand Certain Things. If An Insurance Company Has Misrepresented Your Policy, Not Processed Your Claim Promptly, Or Denied Your Claim Based On Grounds That Are Unreasonable Or Have Not Been Clearly Explained To You, Your Insurance Rights Have Been Violated, Letting Them Know That You Are Aware Of The Infraction Can Often Help Things Along.
Be Persistent Keep In Mind That Insurance Companies Have A Tough Job. They Must Constantly Search For Those Who Would Abuse Their Policy Terms And Sometimes You Might Get Caught In The Net. However, Let Them Know You Will Not Stand For An Unpaid Claim. Keep Calling, And Continue Demanding That Your Needs Be Met.
Such things as a misspelled name or a name that does not match the policy, or an inaccurate transfer of the subscriber and group numbers to the filed claim can all lead directly to a claim denial.
Another important initial step is to make sure that the healthcare provider that will be filing the claim for payment is listed under the policy's network of eligible providers. If the healthcare provider is not listed within the network of providers than the claim cannot be accepted and completed.
After taking the time to double check that the personal information on the account is accurate, a person can further secure their claim by verifying that they are still under coverage by the insurance policy and that the correct primary insurance is listed. In addition, one should confirm that they are eligible for the benefits listed and that the policy information is up to date with detailed explanations of coverage to match the filed claim.
1. Patient harm. The worst of all complaints are the valid ones that are genuinely the doctor's fault. Individual health insurance plans are in place specifically to be able to avoid any problems, but a misdiagnosis can easily create one. If doctors aren't weighting all the options before making a decision of treatment, patients have every right to complain.
Healthcare claim denial, or the refusal to honor a claim by one's insurance company, is a more than common occurrence within the United States, but it does not need to be.
According to a study done in 2010 by the US Government Accountability Office and the Department of Health and Human Services, the claim denial rate on filed medical insurance claims for the first quarter of 2010 was nineteen percent.
This is a shockingly high number of claim denials when one considers that it equals just fewer than one in five claims that are being denied; that is nearly one in five people who are stuck paying for the costly medical claims by themselves out of their own pockets.
7. Poor bedside manner. They may not teach bedside manner in medical school, but it is crucial in the medical field. Patients do not feel like they can trust their doctors if they can't make eye contact, continuously look at the clock, or interrupt them.
Knowing Your Legal Rights As A Client Of Your Insurance Company Can Help You Know What You Have The Power To Demand Certain Things. If An Insurance Company Has Misrepresented Your Policy, Not Processed Your Claim Promptly, Or Denied Your Claim Based On Grounds That Are Unreasonable Or Have Not Been Clearly Explained To You, Your Insurance Rights Have Been Violated, Letting Them Know That You Are Aware Of The Infraction Can Often Help Things Along.
Be Persistent Keep In Mind That Insurance Companies Have A Tough Job. They Must Constantly Search For Those Who Would Abuse Their Policy Terms And Sometimes You Might Get Caught In The Net. However, Let Them Know You Will Not Stand For An Unpaid Claim. Keep Calling, And Continue Demanding That Your Needs Be Met.
Such things as a misspelled name or a name that does not match the policy, or an inaccurate transfer of the subscriber and group numbers to the filed claim can all lead directly to a claim denial.
Another important initial step is to make sure that the healthcare provider that will be filing the claim for payment is listed under the policy's network of eligible providers. If the healthcare provider is not listed within the network of providers than the claim cannot be accepted and completed.
After taking the time to double check that the personal information on the account is accurate, a person can further secure their claim by verifying that they are still under coverage by the insurance policy and that the correct primary insurance is listed. In addition, one should confirm that they are eligible for the benefits listed and that the policy information is up to date with detailed explanations of coverage to match the filed claim.
1. Patient harm. The worst of all complaints are the valid ones that are genuinely the doctor's fault. Individual health insurance plans are in place specifically to be able to avoid any problems, but a misdiagnosis can easily create one. If doctors aren't weighting all the options before making a decision of treatment, patients have every right to complain.
About the Author:
Altius Coventry Health Care is pleased to be your companion in good health care benefits. In addition to health plans for businesses of all sizes, we also offer family and affordable health insurance as well as coverage for Medicare beneficiaries.
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