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Resolving Your Health Insurance Claims Dispute

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Resolving Your Health Insurance Claims Dispute

Resolving Your Health Insurance Claims Dispute

If you have purchased your health insurance policy, then it makes it important to ask for itemized bill from the service provider as well as hospital where you have received your treatment. Resolving health insurance claims dispute is not difficult if some points are followed carefully. Firstly, one needs to check the Explanation of Benefit (EOB). The EOB explains in detail about the items charged less the agreed items of the insurer. The difference being what you have to pay. One must read the EOB thoroughly to safeguard against overpaying while dealing with your claims on health insurance.

One must read the policy information carefully to see that all the information about policy details are provided correctly. Make sure that the “allowable” rate that the insurer had set at the time of signing the policy is charged on your name.

Check to see that the paid deductible has been credited and providers are not taken outside of the network. There could be some other errors in EOB like up-coding (which is charging for expensive services that you have not received), legitimate claims that the insurer disagrees to provide as it considers it to be a medical unnecessary and “unbundling”, (i.e., breaking down of single procedure and show it as many).

Resolving Health Insurance Claims Dispute

There are certain points that need to be followed to resolve disputes arising with your health insurance claims. These include:

  • Collect all the paperwork related to your health insurance. These are the policy documents that mention what is covered with your policy and bills from the doctor and hospital.
  • Carefully read all your policy documents. There are cases where the medical services provided are excluded explicitly in the policy document. Again, it could be that the health care procedure in question is either not mentioned specifically in the documents or else the statements mentioned in the policy documents are open to different interpretations. In this situation, it is worthwhile to note the sections that specifically relates to your medical situation.
  • Make a call to your insurance company. You explain them why you think that your denial of your claim was an error on the part of the company. Get the name of the person with whom you speak and also get a date by which the company will resolve your dispute. If your dispute is not resolved by that date, call them back.
  • Make a document of all the phone calls that you have with the insurance company.
  • Do not give up till your claim is resolved. Make every effort to find a solution to your dispute. You can contact the department of insurance of your state to file your appeal for resolving your case.

Estimation has revealed that around 50 percent of all hospital bills have some kind of errors in them. The number of errors rises if a bill is of 15 pages long and contains details of every medical supply that may include aspirin.


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