Six Essential Items When Communicating with the Insurance Company

Despite the best efforts of most doctors, claims are frequently denied due to information that is inaccurate or missing from your medical forms/bills that are submitted by the doctor’s office to the insurance company. To help avoid unnecessary claim denials, have the following six items available for all written and phone communications, as well as hospital or health related visits.

• Group insurance name and policy number.
• Insurance identification number
• Date of birth
• Date health coverage commenced
• Your social security number
• The name, social security number and date of birth of the person who is the main policy holder

Reducing the Chances of Claims Being Denied

At the onset, it is fundamental to thoroughly understand your health insurance policy. Knowing what is covered and not covered will reduce the number of conflicts you will encounter with your provider. In particular, it is important to know the following information about your health insurance to reduce your chances of having a claim denied.

1. First and foremost, be aware of what conditions are covered, along with the limitations of your policy.
2. Determine if an authorization is required for specialized services or an inpatient hospital stay.
3. Know the maximum benefit coverage.
4. If you cannot find the answer in your policy or if you don’t understand the wording, contact the insurance company to clarify anything that is not clear or that you don’t understand.
5. Another good practice is to contact the doctor’s office before an appointment is made to make sure he/she still has a contract with your provider, since the web site or the printed sheet of listing physicians may not always be up to date.
6. Also, be aware that when you receive a written authorization for a specific procedure, surgery or physical therapy, there is usually a specific time frame given with a beginning and ending date. The authorization will not be valid and payments will not be made if you do not adhere this “window of time” listed in your authorization letter.