Becoming familiar with the different reasons why your health benefit claims can get denied can help limit the number of denials and misunderstandings that occur between the patient and the health provider. And here are some helpful tips to make sure your transaction in claiming for your health insurance benefits will be hassle-free.
CHECK YOUR COVERAGE INCLUSIONS
Different plans come with different inclusions. Check your coverage inclusions carefully to see if your request is included in your plan.
CHECK YOUR PRE-EXISTING CONDITION (PEC)
A pre-existing condition (PEC) is a medical condition that started before a person’s health insurance went into effect. Check if you have PEC coverage or which PEC’s are included.
MAKE SURE YOU HAVE PROPER AUTHORIZATION
You must have an approved Letter of Authorization (LOA) before any procedure (except for emergencies), and any claims.
MAKE SURE YOUR REQUEST IS MEDICALLY NECESSARY
For LOA approvals, submit documents on why a procedure or service is being requested. Ask your healthcare provider to give you more information regarding your request.