Almost everyone has heard a story about an insurance company that refused to pay for the damage because of some supervision of the policyholder. To protect insurers against fraud, insurance companies pay hundreds of thousands of dollars annually to investigators, surveyors and experts. These professionals are at the forefront of the fight against fraudulent claims and unfair policyholders, saving consumers insurance costs in the long run.
It is sad that honest people with legitimate claims are trapped in the red tape of the investigation. They often find themselves in a situation where their claims are rejected because of minor miscalculations or policies of which they were unaware before the application was made.
Knowing and understanding how insurance companies and their staff conduct their research will be very helpful to you on the day you need to make a medical claim. By taking these precautions, you can avoid discussing with the insurance company any medical expenses that you feel should have been covered.
Protection against refusal of insurance
Consider these simple steps that can help avoid costly and time-consuming insurance errors for many policyholders.
Check all supplier documents carefully. This step is a “cross-reference to the triplets and the dots on the i’s” you can take to make sure all the information on the long forms you fill out in the doctor’s office is correct. Name, spelling, addresses, insurance policy numbers, date of birth, employee name, etc. From next year, the new government standards will give patients better computer access to their medical records and will allow them to make corrections and updates online if necessary.
Insight into the new IC-10 coding system With more than 55,000 new codes added, the risk of errors in this area can be high. Something as simple as the code for an injury on the left side of the body, when the injury is actually on the right side, is enough to disqualify your claim.
Always carry your current health insurance card with you. Insurance companies often send new health cards when they make changes to your policy. Be aware of changes in their services and always replace your old card to avoid surprises.
If you think your application has been wrongfully rejected before you can appeal, seek advice from the national insurance agency. Get all the documents you need from the doctors to find out why you need the procedure to file your claim. They should also include information about the need to leave your network unless you have another choice.
There is a constant battle between the insurance companies and those who want to defraud them. If the legitimate claims of honest people are automatically classified as suspicious or fraudulent, then unfortunately they are forced to fight for the services they have paid for and now deserve. The best advice is to be vigilant, keep good records, know your policies and ask a lot of questions.