Tag: claim

Medical Claim Forms

What is a medical claim? A medical claim is a bill for services provided by a health care provider, forwarded to an insurance company for payment. The claims made by a person or on his behalf by the hospital, will cover only those expenses that fall under the parameters of the policy chosen. So careful research must be done while choosing the policy.

There are different types of medical claim forms. Some of them require a direct interaction between you and the insurance agent, while others are routed directly through the hospital. For those forms, that require the claimant to fill out all the details in the medical claim form, there are certain aspects that need to be kept in mind. The medical claim forms require way many details and it is important that they are filled out with utmost attention. Wrong entry or a missing entry can cost the whole claim being denied.

Medical claim forms ask for details such as name, age, sex, bank account numbers, relationship status, place of work, the nature of illness, number of days applied for leave. Apart from these, the date of admission into the hospital and the date of discharge and the amount charged for the services are also asked.

There are different types of medical claim forms. Some of them are Balance Forward Bill, Form 1500, which is otherwise called HCFA and UB-04. Each has a different method of paying the provider for the services.

The Balance Forward Bill is a simple bill sent by the medical provider to the patient for the services provided. This does not include the necessary details that are required by the insurance agent. The most commonly used medical claim form is the Form 1500 or HCFA. This is of the standardized format. This is either forwarded to the insurance agency, if the medical service provided is contracted to the same. Otherwise, the patient gets to pay for the services initially and these medical claim forms can be sent to the insurance agent for reimbursement. The other type of medical claim form is the UB-04, which also works like the HCFA.

Most of the insurance claims require standardized medical claim forms. This is because the medical claims are processed using a unique code. Once a claim is submitted, the system scans the claim using the patient information and the unique code and processes the claim based on the plan chosen.

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Health Insurance And Claim Process

Comprehensive health insurance is the need of hour. With medical facilities becoming dearer day by day the working class can rest at peace only if they have a good health insurance policy in place. This would ensure that you get proper medical attention when required, without worrying about your savings.

How does health insurance work?

The purpose of health insurance is to raise finance when a medical emergency strikes. When you purchase a health insurance plan you are provided with health care card and list of network hospitals where you can avail treatment without paying anything from your own pocket. If you are going for a planned treatment, just intimate your health care provider and the name of network hospital so that your provider can send approval to the hospital authorities in advance and you can seek treatment. In case of emergency treatment, inform the authorities as soon as possible. Even if the approval takes time, go ahead with the treatment and later on file the claim. If you seek treatment in non-network hospital even then you can file a claim and get reimbursement.

How does insurance claim process work?

There are two types of claims:

Cashless settlement: If you avail treatment in network hospital, the claim is directly settled between the insurance authorities and hospital. This is one of the best facilities provided by health insurance providers as at times arranging finance at last moment leads to delay in treatment which can prove stressful.

Reimbursement: It may happen that you face an emergency and rush to the nearest hospital to get the treatment, which is not on the network of your health insurance company.. In this case, you can file a claim for reimbursement after discharge.

To file reimbursement you need to submit the following documents in original:
Discharge summary
Lab investigation reports
Doctors prescription
Medical bills

While applying for reimbursements pay heed to the following:
Fill in the reimbursement claim form and submit it timely
Check the stipulated time frame in which you need to submit the documents. Generally, it is 30 days post discharge
Read carefully list of all the documents that need to be submitted
Pre and post hospitalization expenses are also covered, so do read the related policy carefully

The insurance claim process is not a tedious task as assumed by many provided you follow the process carefully and timely. Health insurance is a facility for people to make their life easier. Hence, get a comprehensive health insurance and live peacefully.

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