Here are
some of the practical steps you can take to win back your claim;
- · Seek the support of advocates
- · Re-apply again
- · Know/research why your application was decline
- · Keep electronic filling record
- · Know the cost of your treatment.
Support of advocates
Seek the
supports of advocates such as your doctor, hospital and Health Insurance
Company. The social workers in many hospitals would be of great help to you in
reclaim your health insurance claim. They will be of greater help in submitting
a correct paper work.
Your doctor
can help you to clarify any incomplete information in your claim to your
healthcare insurance company. Your doctor could also be of help if your denial
is as a result of insufficient medical necessity, in such case your doctor
would help you write a letter of medical necessity, to let your health
insurance company know how necessary this denied treatment was for your health.
Re-apply again.
If you
re-apply your claim, you could eventually get an approval because Insurance
companies makes use of auditing software called “claim review program” to check
through millions of submitted claims from their clients.
This
software works to find technical errors in billing codes that all doctors, hospitals and clinics
submits for payment.
Different
insurance company uses different program algorithm for their review software,
therefore the reasons for denial or approval of a health insurance claim are
not the same from one insurer to the other.
However,
regardless of the differences, the more time you re-apply the higher your odds
of approval.
If the
reason for rejecting your claim is as a result of a technical error coding or
untimely filling if you re-apply once your claim can be approved. In contrast, if
the reason for rejecting your claim is as a result of your policy coverage, you
will have to re-apply more than once before your claim can be approved.
Research
why your application was decline.
There are
numerous reasons why your health care insurance claim can be decline, whenever you
file a claim and been decline one of the best thing you should do is to know
the main reason why your application was rejected.
This knowledge will be a
sure guide to doing it right next time when you need to file a health insurance
claim again.
Some of the Reasons for a health insurance claim denial include;
- If you don’t have a complete insurance information.
- There was a lack of prior-authorization.
- Non capture of test.
- You might have past timely filling limits.
- If you have an Insufficient medical necessity.
Keep electronic filling record
Records of
your claim filling needs to be kept for a good reference purpose. Ask for
copies of your fillings from your doctor, a well kept record of claim will save
you from another rejection when you file your claim again.
Know the cost of your treatment.
The cause of
your claim denial could basically be due to a high treatment cost.
Endeavour to
know the total price of your health treatment, know how much your insurance
company would have to pay on your behave and know how much you will personally
pay, if you are equipped with all these knowledge you can easily know if your
insurer is trying to avoid paying a huge medical bill on your behave and hence
deny your health insurance claim.
Be rest
assured that you can actually get your claim fulfill even after a prior denier,
if you check through what is missing in your initial claim and know the actual
cause for the claim decline.
