Tuesday, April 7, 2009

Medical Claims Solutions: Odell Helps You Deal With Insurance Companies

At AgeInPlace I found a woman with over 15 years experience with medical claims processing who aids individuals manage their own medical claims. She aims to reduce out-of-pocket medical expenses, decrease time dealing with insurance companies and increase access to needed medical care.  

Clarisa Odell presents 10 steps to get proper coverage so your medical claims aren't delayed or denied:

1. Review your evidence of coverage or policy disclosure document to understand your coverage, deductibles and limits.  This way you might be able to pinpoint options with your doctor which can be covered.

2. Bring your current medical insurance information to every doctor's visit.  Provide the office with your most recent information.  Additionally, let them know where your claims need to be sent.

3. Check to make sure your doctor bills your insurance directly.  However, if he/she doesn't, get a detailed bill with complete procedure and diagnosis code information and submit this information with a claim form to your own insurance company.

4. Ask the doctors office to check with your insurance provider to determine that you are covered not only for the visit but also for the procedure.  If a pre-authorization is required for the treatment, get it prior to all major medical procedures. 
5. Make sure the doctor is submitting your claim (on the most current claim form) in a timely manner.

6. Make sure you review and understand the Explanation of Benefits (EOB) statement--what is covered, what isn't and what is applied towards the deductible.

7. Speak to and document any conversation with your insurance carrier about all questions and about disputed claims.

8. Be clear about the issue you are questioning your agent.  Be courteous but persistent.

9. Understand both your prescription benefits and your medication coverage to determine whether or not a generic counterpart may be covered.

10. Get help from third party resources, like Medicare and other agencies. 
The more you understand the problem with your medical claim, the more likely you are to have them handled satisfactorily.  

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