Health Insurance Articles
How Surgeries Are Claimed Through Health Insurance Benefits
2010-09-13
Health insurance coverage quotes can be all over the map these days -companies offer everything from the most basic, low-maximum policy to no annual limit policies that allow clients to spend as much as they need or want to, with an appropriately large price tag attached. For the average individual who is looking to understand how their insurance policy works and how they can claim the treatment they have received, the online and corporate world of insurance can seem sterile and distance. For example, one of the most common claims in the health insurance industry is a surgery claim. This can be for something simple such as a hernia or more complicated such as a bypass. In any case, it is important to understand the basic procedures that need to be followed in order to successfully complete a claim.
First, start by looking at what is known as the "certificate of coverage" that all insurance companies are obligated to provide after clients have purchased health insurance coverage quotes. On this certificate, it will list exactly what the company will not cover under your policy. If it is unclear, call your insurance provider and ask what is covered and what isn't. If it appears your surgery is covered, make an appointment with your doctor, who should then be able to refer you to a specialist who can determine exactly what kind of surgery you will need. Once that has been completed, make sure to get a referral letter from your doctor supporting your need for this surgery. It is important to have as much of a paper trail as possible, including any and all contacts with your insurance company so if there is a challenge to your claim, you will have data on-hand to fight it.
Before the surgery day arrives, you will be required to provide all relevant insurance information to the hospital you will be having surgery in. They will likely be within your network of care unless the surgery is very specialized and will be able to submit the paperwork to your insurance company on your behalf. As soon as you are well enough to do so, call and inquire with your company about the status of your surgery claim. Ask if it is being processed; and if not, why not. Ask you long it will take before you receive compensation and ask just how much of the surgery is being covered and why.
Insurance companies respond well to both good documentation and the squeaky wheel. Be sure to call every few weeks to check on the progress of your surgery claim and be ready with any documents to support your need for surgery.
