1. Provide accurate and complete information.

If your doctor's office files the health insurance claim for you, the first thing you need to do is be sure that they have the correct health insurance information for you or the family member who is being treated. Be sure that they have the correct birth date, social security number, correct health insurance group and member numbers.

When you have to file your own health insurance claim, it's important to follow the procedure your health insurance company has set up. Most companies will have a specific claim form they want you to use. If you don't already have one, contact them to obtain one. You might also be able to download one from their internet site. Attach a copy of your doctor or prescription bill to the health insurance claim form. Make sure the copy is legible and complete with a patient name, diagnosis, date of service, and itemized charges.

Once again, entering the correct information is paramount to getting your health insurance claim paid as quickly as possible. If you look at a claim form and you are not sure what information is required for a particular field, contact the health insurance company for clarification.

2. Keep track of every health insurance claim you     submit.

Keep track of each time you see the doctor. If you haven't heard anything from your insurance company by the time your doctor's office sends you the first bill, you should call the insurance company directly. Most doctors' offices will show on their billing statement which date they filed the claim.

When you call, be prepared to provide your member number, your group number, the name of the medical provider, and the date of service. If you have a copy of the bill, have that in front of you when you make the call. Just tell them that you are calling for status on a claim. Either they will tell you they have not received the claim or they will tell you where it is in the claims process.

If they say they have never received the claim, verify the correct mailing address and send a second copy as soon as possible. If they tell you it has been processed and an Explanation of Benefits will be going out on a particular date, make a note of the date and be sure that you do receive something.

3. Be persistent in your follow up.

You must continue to be persistent when trying to get your claim paid. Assuming that your insurance company does not have to investigate your claim for any reason, you should expect payment with 30 days. If they are conducting an investigation, it all depends on how quickly they receive the requested information -- either from you or your medical providers.

Steven D. Smith is a licensed life and health insurance professional and CEO of SDS Financial, LLC.  He is also the author of the “ 2008 Guide to Choosing and Using Your Health Insurance Plan” and “ Your Guide To Good Health Insurance”.  Other articles and books about Health Insurance written by Steven Smith can be found at his website www.AvoidingBadHealthInsurance.com  

Source: http://www.AvoidingBadHealthInsurance.com

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