Health Insurance Claim
A health insurance claim is a bill submitted to the health insurance company for the health care services provided by the doctor. Insurance companies offer a number of health insurance plans and each plan has its own way of dealing with claims. In many policies, the front office staff at the hospital or the doctor’s office takes care of the paperwork and files the cliam straight to the company. Every time you visit your doctor, you have to fill a form with all the information about the insurance policy and then hand over your insurance card. The receptionist, after getting therelevant information submits the bill for the service to the claim processing centre of the insurance company for payment. The processing centre is generally a centralized unit looking into claims submitted by members of a policy located in far away places.
The centre takes all the information from the doctor, such as patient intake forms, information sheet and services documentation. These are now examined in the light of claims that are covered under the policy that you have taken. If you are entitled for the claim, the company will pay for that and if not, you have to bear the expenses for your treatment. In many policies, you have to file the claim yourself. In such cases, you have to pay the bill upfront and then seek for reimbursment from your insurance company. For reimursment, you have to fill out lengthy form and send it to the insurance company and you can get the reimbursment after a couple of weeks.
Most claim processes are generally smooth, but many a times there may be some problems. The Insurance company can reject the claim on a few grounds, such as if your policy does not cover the mediction or procedure or if the company finds it medically unessasary or experimental. It can also reject claims if you do not file it within a prescribed time span. In case of any despute, it is advisable to ask the compny to explain the grounds on which the claim has been rejected. The Commonwealth Ombudsman also helps the people in Australia to resolve the matter in case of such disputes.