Health Insurance Claims – Providing Monetary Benefits for Medical Expenses


A health insurance claim is made to call for an instant action. To speak the truth, uncertainty forces us to go for a suitable healthcare insurance plan as it will provide us with coverage for medical expenses. Importance of a health insurance policy is best realized in times of critical health condition. You will make claims for health insurance when you are in need of emergency medical service.

Fortunately, it is not difficult – though definitely not a child’s play – to file an insurance claim. On other side, you cannot expect claim processing to happen very quickly. There is a chance that you will be kept waiting for a long time or your application may not be approved by the insurer. The right choice – in this regard – could turn out to be a life-saving and life-changing decision for you.

It is not uncommon for the common people to get confused over making an intelligent choice from so many health care insurance schemes. Contact law offices of Nancy L. Cavey to receive authentic guidance. You will get to make an educated decision and expect your insurance claims to be processed faster.

Your health insurance claims may be denied due to any of the following reasons:

  • Errors in application
  • Filing claims outside specified time limits
  • Seeking treatment sans recommendation
  • Seeking treatment not covered under the policy
  • Going for unnecessary medical procedures

When to Make a Health Insurance Policy Claim?

Insurance companies are very alert these days to identify the fraudulent health insurance claims and dismiss the same. In order to get your application approved, make sure to properly fill up the blank spaces. Provide authentic information as the insurer will verify these and any mismatch is enough to face rejection. It is also important to ensure that you are seeking medical attention recommended by a physician.

Health insurance claims are mostly sought after when you are in immediate need, such as you have met an accident or are suffering from illness. You may also file an application for insurance benefits if urgent care service is required outside of regular clinic times.

Always make sure to coordinate with the representatives from your insurer before opting for a particular medical procedure to know about different aspects covered under your health insurance plans.

Different Types of Health Insurance Claims

Health Maintenance Organization- According to an EMO plan, an insurance scheme provides coverage only if you undergo treatment at an accredited healthcare centre and/or under the supervision of a qualified doctor.

Preferred Provider Organization – As per a PPO plan, you are allowed to seek medical service from a preferred healthcare professional.

Health Maintenance Organization – A health care policy – under the category of HMO – provides coverage for medical expenses sought or received from an accredited hospital or doctor.

Group Health Insurance Plan – An individual, who is a part of a group health insurance policy, can file a claim for medical expenses on several grounds. The members are allowed to seek reimbursement for medical expenses due to cognitive disorder, degenerative condition, prolonged sickness or other chronic health-related problems.

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