Health Insurance Articles

The Healthcare Claims Approval Process And Its Timeline

2010-06-10

Ideally, health insurance coverage will be used often for routine check ups and prescription drug purchases, but very rarely for any serious emergencies, as no one truly wants to test the service claims of their insurance company. But although no one wants it to happen, chances are that during the life of any health insurance coverage policy, a large or unexpected claim will need to be made. In those cases, many consumers are left wondering exactly what the claims process is and how long it will take them to receive a payout.

For standard services, such as a doctor's visit, most health insurance coverage comes with two options - direct billing or the filling out of forms. In direct billing, one form must be filled out on the first visit to the doctor, and after that the bill is simply sent directly to the insurance provider. If there are any discrepancies or extra money owed, the client will be advised. In a forms-only situation, a patient must fill out forms each time they attend the doctor and then submit these to their provider, who will then issue a check. It is a great deal more time consuming, and most companies are steering away from this method, but some providers still require paperwork from their clients for each visit.

In the case of an unusual or emergency situation, however, many patients are at a loss. Fortunately, most major insurance companies are listed in city hospitals and treatment facilities, and a signature by the policyholder or next of kin is typically all that is required to start treatment. Depending on the type of facility visited, they may not be set up to directly bill insurance companies, and often the bill will fall to the patient to pay. Before shelling out one cent, however, call the insurance company and confirm exactly what is covered and what is not. Make sure to collect any and all documentation provided by the hospital and do not pay the bill until you have settled the matter with you insurance provider. Once the money for any treatment has come out of pocket, it is very difficult to recoup it.

Once the proper paperwork has been filed, the waiting begins. With electronic healthcare claims systems used by many insurers, healthcare claims can often be processed within a week. An odd circumstance or one where a treatment or outcome is in doubt, can easily push this back by several weeks or even a month, however. While no one likes having to make a claim on their insurance, having a responsive company and being diligent with documentation can greatly increase the speed of any healthcare claim approval.