How to Make a Health Insurance Claim

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Your health insurance coverage provides you and your loved ones with a great safety net in the event of any medical emergency or situation. Depending on your plan, health insurers will cover various treatments and services to accommodate any condition, pre-existing or otherwise.

When it comes time to call upon your health coverage to take care of expenses, filing a claim can be a frustrating process, but there are some simple steps to make sure that your insurance company does its part in protecting you and prioritizing your health care.


Know your plan.

Be sure to have all of your medical information updated. Whether your coverage is Medicare, Medicaid, or any private health insurance coverage, have your most recent insurance card at the ready. If you haven’t received one recently from your insurance company, be sure to check for a helpline on the back of your current card or an email address to even receive a temporary downloadable copy for reference.

If you choose a private insurance company through open enrollment, be aware that these larger insurers have multiple health care plans that fall under their umbrella. Claims may not be processed properly if submitted under the incorrect plan, such as an HMO, PPO, EPO, point of service plan, or high deductible plan.

Have everything in order.

Filing a health insurance claim is an effort in futility if you don’t have all of your paperwork in order. When going to your health care provider, be sure to receive an outlined and itemized bill detailing the services you received. Private insurance companies will ask that you attach original itemized invoices to the claim form for a full understanding of what the claim is related to. Be sure to review these bills to check for any errors in personal information or medical coding before preparing the documents for your health insurance company.

Your health insurance coverage should provide access to a claim form through their website or be able to mail it to your home. Depending on your health insurance plan, claim forms may have additional instructions about what other information you may need to get from your care providers.

As previously mentioned, health insurance companies will need the original documents for review, so be sure to make copies of everything for your personal records. This will allow your health plan to move forward with the claim process with greater ease. It will also help in the event you need to re-file your health insurance claim to seek a second look or in the event, your claim gets lost in the system.


Consult your doctors.

It’s important when looking into services and treatments that you learn what may or may not be covered by your health insurance plan. Health insurance coverage can have exclusions depending on your plan, even for cases with Medicare and companies in the health insurance marketplace.

In some cases, clinical trials and experimental treatments, like in the case of Alzheimers research, may not be taken on by your HMO or other health insurance plan. This could also impact the cost of home care for patients with Alzheimer’s disease and dementia. In most cases, earlier diagnosis and knowledge of risk factors has helped a number of people develop better treatment plans for these diseases. A study by the Alzheimer’s Research Foundation found that 40 percent of Alzheimer’s cases can be delayed, or even prevented, by lifestyle changes like reducing alcohol consumption and quitting smoking.

Caregivers should be made aware of the out-of-pocket cost to look into other potential outlets to cover the expenses. Some clinical trials work, but patients and their loved ones need to be in the know on price.

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