Policy or certificate of participants and participant handbooks of your health insurance should be stored carefully. Learn and follow the provisions of your policy. For example, if your insurance requires prior approval for surgery or other action from the insurance company, you should get it before the action undertaken. If you must get a referral to visit a family doctor to a specialist, get a referral is. Check the back of your insurance company's list of partners to ensure the hospital you choose is included in the network. Hospitals can exit / entry from the list of partners each time. You also need to confirm to the admissions officer / hospital admission. Know the limits set time. How long does a referral or consent valid? When the claim file to be delivered?
Know the limits of maximum benefit to your health insurance coverage. If necessary, ask your insurer how much benefit remaining for each type and the type of treatment. Know also the type of care is not covered or have to go through the waiting period, if any.
2. Tell your doctor / hospital restrictions and rules of the relevant policy
You can direct your doctors and hospitals to follow insurance procedures. Ask for their help to get referrals or other approval for medical treatment. You especially have to be careful when you get care outside the network partners with the reimbursement system (reimbursement) because of incompleteness or inconsistency of the procedure can make your claim is denied, paid in part or delayed the process. If the doctor gives a diagnosis, tell what diseases are covered and what is not. Often, the slight difference in the mention of an alternative diagnosis or diagnosis (differential diagnosis) can have a major impact on the decision of the claim. Be sure billing staff / financial hospital attach evidence of the complete bill. Write down their phone numbers if at any time you require assistance.
3. Keep all records with either
Write down all the care you receive, when, by whom, and why. Also, copy the file the bill, a list of benefits from insurance providers and all other documents from doctors, hospitals, pharmacies, and insurance companies.
4. Contact your insurance company's service department
Whenever you have questions or concerns, contact your insurance company directly for assistance. Try to be polite and calm even if you feel frustrated. If necessary, ask to speak with a supervisor of staff services. Write down the date and time of your call, name of staff who spoke to you, and what they say. If you do not get the help you need, you can submit a complaint or request in writing via email or fax.
5. Do not easily accept rejection
Insurance companies can make mistakes. If you do not pay health insurance fees according to you, including the scope of coverage, ask them to review the decision by submitting your argument. Contact the personnel / human resources of your company (for group insurance) or your insurance agent (for individual insurance) so that they make a complaint on your behalf. If this does not bring results, consider making a formal complaint letter. All health insurers have procedures for settlement of complaints and other disputes. Your guide book may explain the filing procedure.
If you or your health care provider was informed that certain procedures are not covered, learn whether you can ask for higher management in the insurance company to reconsider. In some cases, different people in the same insurance company can make a different conclusion. There is often a good idea to request a review of claims decisions. In situations where you think that the insurance company has treated you unfairly, only with the involvement of lawyers can make the rejection revoked without due process of litigation.
