Get Paid Out: 5 Tips for Understanding the Medical Claims Process

Posted by Casandra Properties on Friday, June 19th, 2020 at 3:55pm.

If you're trying to get paid for a medical claim, you'll need a basic understanding of the process. But, if you're new to using health insurance or making your very first health claim, it can be hard to know where to begin.

Sound familiar?

If so, this is your article! Keep reading for five helpful tips to help you understand the medical claims process, and start on the path to payment today.

Medical Claims Process

The Medical Claims Process Made Easy

No matter what kind of claim you're making, prompt payment is a top priority. Keep these tips in mind to make sure you get paid quickly - and for the correct amount.

1. Verify Coverage Before Your Procedure

In most cases, your doctor or provider will be filing your claim for you. But, it's still vital to ensure that you have coverage before you get treatment. Otherwise, you could be stuck with a big medical bill.

Be sure to verify your plan's coverage and get a preapproval letter, if necessary, before starting any kind of treatment. 

2. Fast and Accurate Self-Filing

While medical claims might be delayed or rejected for a variety of reasons, human error is a top cause for denial. In fact, over 40% of claims are coded incorrectly, and nearly 20% lack proper documentation. 

To avoid this common issue, be sure to use the proper claims form and procedure number provided by your insurance company and doctor's office. And, when in doubt, call to verify this information before submitting your claim. 

3. Keep Track of Your Claim

After making a health insurance claim, you'll need to keep track of its processing. Otherwise, you might wait longer for payment. This also includes verifying that your medical claim is being processed for the correct total.

Keeping a detailed record of your copays, annual deductible, and out-of-pocket maximum throughout the year will make this step easier. Don't get stuck starting from square one, or guessing at how much coverage you have! 

4. Review Everything

After filing your claim, you'll receive an EOB or an explanation of benefits. Review this alongside your medical bills to be sure that all the information matches. And, if there is any discrepancy you'll want to contact your doctor's office and insurance provider right away.

Even if your claim is paid quickly and without issue, keep these documents on file. You never know when you might make another medical claim, and detailed record-keeping can come in handy later on!

5. Know When to Get Help

If your claim has been rejected or denied and you believe that you are entitled to a payout, you might need legal help. Don't spend hours arguing with your insurance company or talking in circles with the billing department. Instead, contact the professionals.

While hiring a lawyer might sound intimidating, it's one of the fastest and most foolproof ways to get your claim paid. For more information on using your insurance and receiving full benefits after making a medical claim, read this helpful article.

Fast Payment of Your Health Insurance Claim 

Armed with these top tips for navigating the medical claims process, you're ready to get paid out fast.

Did you find this article helpful? If so, check out the rest of our blog. It's packed with tips and advice on health, lifestyle, decorating, and more!

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