WORK-LIFE BALANCE / JAN. 25, 2015
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How to Claim Your Medical Insurance

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If you find yourself sick and in need of medical attention, you’ll thank your lucky stars that you have medical insurance. Most medical insurance will cover the majority (if not ALL) of your medical expenses and all you need to do, is cover the "co-payment". This is the same as the "deductible" on your car insurance--the token amount you pay.

Remember: your medical insurance company is ONLY responsible for paying out if the problem is covered by your policy. Before you can claim the medical insurance, make sure to read over your medical insurance policy thoroughly to find out if the problem being treated is actually covered.

The truth is that claiming your medical insurance is a fairly simple process:

Step 1: Go to the doctor’s office

When you find yourself in need of medical attention, the only place, you’re going to get it is at the hospital, clinic, or doctor’s office. When you arrive at the doctor’s office, ask to ensure that they accept your insurance policy and that the insurance company accepts them. You can ask your insurance representative for a list of all hospitals, clinics, and doctors that are accepted under the medical coverage.

Step 2: Fill out the intake form

You will be given a form to fill out upon entering the hospital or clinic. The form will ask for details about your medical history, but it will also ask for your insurance information. You will need your medical insurance card on hand as it contains all of the information the hospital or clinic will need to submit the insurance claim.

Step 3: Get treated

Don’t worry about anything, but let the doctors help you deal with whatever the problem is that brings you to the hospital. Rest, recover and feel better!

Step 4: Pay the co-payment

Remember, the co-payment is the amount that YOU pay to cover the cost of your medical treatment. It tends to range anywhere from 10 to 40%, depending on the amount that you have established with your insurance company. If the co-payment is very large, you may have to agree on a payment plan with the hospital. If it is a small co-payment, settle the bill there and then.

Step 5: Let the hospital submit the claim

The medical insurance claim will be filed by the hospital or clinic, and it will be sent directly to your insurance company. If the insurance company sees that everything is in order, they will pay out the money to cover the cost of your medical care.

Here are a few things that would cause the insurance company to DENY the claim:

  • Inaccurate or incomplete insurance information
  • Non-capture of tests or procedures
  • The hospital filed the claim too late
  • The medical attention was deemed "insufficiently necessary" (usually with cosmetic procedures)
  • Lack of prior authorization or pre-certification by the insurance company
  • Errors or omissions in the diagnosis and treatment procedures

These are all things that would lead to your claim being denied, but they are highly unlikely if you are treated at a well-known clinic or hospital.

As you can see, the process of claiming your medical insurance is not that hard. It’s designed to be that way so that you can go about getting the help you need without having to worry about dealing with medical bills and massive expenses!

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