Health Insurance – Understanding The Claims Procedure

  

Having got your health insurance policy you would think that things would be fairly straightforward when it comes to making a claim. Unfortunately, that’s not always the case. There are a large number of companies selling health insurance today and each one will have its own set of rules when it comes to making a claim. Indeed, even within individual companies the procedure for making a claim can vary across different types of health insurance policy.

If you’re not sure what to do when it comes to filing a claim for a benefit that is covered under your health insurance policy, then your first port of call should be the company itself. Most insurance companies will offer a toll-free telephone number for claims which is staffed during normal office hours. Normally you will be required to provide some basic information about your policy, such as the policy number and the name of the principal person insured under the policy. With this, the insurance company representative will be able to access details of your policy and advise you how best to proceed with your claim.

If you have a Managed Care Plan, and you are dealing with something that is clearly covered by the plan, then you should find that the process is very simple. More often than not, the staff at the front desk of the medical facility where you receive your treatment will process the necessary paperwork for you. They will input the necessary medical codes for the treatment and services provided and then send the paperwork directly to the insurance company. If a co-payment is required this will typically be paid at the time that treatment is received and you do not need to take any further action until you receive paperwork from the insurance company which corresponds to your treatment. This paperwork will show the percentage paid by the insurance company, how much was applied towards the deductible and whether there is any balance due from you.

Until recently holders of Indemnity Plans were required to pay in full for any treatment provided at the time of treatment. They were then given lengthy claims forms which had to be completed and submitted to the health insurance company for reimbursement. It would then typically take several weeks before reimbursement was made.

Today, it is common for the medical facilities at which treatment is carried out to bill the health insurance company directly and then wait to see what percentage the insurance company pays. If there is any balance due the medical facility will then bill the patient.

In the event of a dispute the medical services provider will bill the patient directly and, in these cases, the patient will need to pay. It then becomes the patient’s responsibility to seek any reimbursement from the health insurance company.

With modern computerized medical billing processes patients today do not normally have any out-of-pocket expenses apart from any co-payment. If patients are required to first meet their deductible the paperwork is still normally forwarded to the insurance company so that an accurate record can be maintained of the policy’s usage and payment history.

Because of the sheer enormity of the cost and the sums of money involved, claims today are normally settled very quickly.

Not only do claims procedures vary between insurance companies but policies also vary widely between states. California health insurance for example will not have the same requirements as Florida health insurance. If you are looking for good low cost health insurance then there is no better place to begin your search than right here online.

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By Donald Saunders

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Florida Property Insurance Changes will Affect Most Homeowners

Florida residents may see an increase in their property insurance as results of a new bill passed at the end of March 2008.

In the wake of Hurricane Katrina and other destructive storms, getting affordable property insurance hasn’t been easy. Many private insurers shed high risk clients after storms in 2004-2005, and raised assessments for others. For those who could no longer afford private insurance (or who were declared insurable by private insurers), state insurer Citizens Property Insurance Corp is the last resort. Over the last year, the state has been attempting to keep property insurance rates low for those who are insured with CPIC. According to critics of the latest property insurance changes, however, Florida residents who are insured by private companies will end up paying more so that the rates can stay low for those insured by the state-owned company. The last week of March saw the Florida Senate approve some changes to property insurance that might end up increasing property insurance rates by around 3%.

The bill was backed by Chief Financial Officer Alex Sink and approved by the Senate Banking and Insurance Committee. The intended effect is to reduce Florida’s Hurricane Catastrophe Fund by $3 billion. This means the state can reduce its investment in CPIC and therefore reduce its risk. At the same time, however, the state has also voted to freeze CPIC insurance rates through to the end of 2009. CPIC insures more than 1.3 Florida residents, and the rate freeze that occurred last year was done to avoid an increase that could have seen rates up by as much as 29%.

The problem is, according to critics, that CPIC’s premiums aren’t high enough, and that the company won’t have enough cash reserves to be able to pay out claims if a major storm hits. This is why the $3 billion reduction in the Hurricane Catastrophe Fund is significant. The Catastrophe Fund is a sort of safety net that can kick into action when Florida is hit by a major hurricane, and is intended to reimburse private insurers a portion of the money they pay out in claims. However, with the fund now reduced by $3 billion, the deficit is likely to be made up by rate increases for homeowners.

Last year, the state actually increased the Catastrophe Fund by $12 billion, but this year has been reduced by $3 billion. The fund was increased last year to reduce costs for insurers, and indirectly for homeowners. However, by increasing the Catastrophe Fund, the state of Florida was also increasing its own level of risk.

The state now wants to start decreasing its investment in the fund to reduce its risk. The net effect, however, will likely be the opposite of that which it originally intended. With private insurers taking on more risk relative to last year, the end result is more than likely going to be increased property insurance rates. The estimate is around 3% overall, with a slightly higher increase possible for Southern Florida residents. Chief Financial Officer Alex Sink admits that an increase in rates is possible, but also says that if insurers try to increase rates to an unreasonable level, the state will step in.

Calum MacKenzie is the Broker/Owner of Real Living Southern Homes a residential real estate brokerage located in Wesley Chapel, Florida and serving the Tampa Florida real estate and Land O’ Lakes real estate markets.

By Calum MacKenzie

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