Setting Up A Health Insurance Record Keeping System
Part 1: The Basic Tools, Chapter 3: Developing a Systematic Approach to Dealing with Health Insurance Page 11
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Step Four: Setting Up A Record Keeping System
Setting up and maintaining a record keeping system is an essential part of ensuring that you obtain the health insurance benefits to which you are entitled. Before sending in a claim, record the name of the medical provider, the date of service, the amount of the bill, the type of treatment or test, and the date you're mailing in the claim on a record keeping form (See Table 9). Record an estimate of the amount of reimbursement that you expect from the insurance company, as well, based on your understanding of your health insurance policy.
Writing down that estimate before mailing the claim to the insurer is a good way to test your understanding of the policy rules and to establish a basis for reviewing the insurance company's reimbursement. When you eventually receive the EOBS from your insurer, note the amount of the actual reimbursement below your estimate on the record keeping form. If you're unsure of what claims have been included in the EOBS, call the company and review the details.
Although you may occasionally make an error, in the overwhelming majority of cases you should be able to accurately estimate the amount of reimbursement that will be provided by your insurer. If you find that your estimates are frequently inac curate, you may need to review your information file to make certain that you've understood the policy rules. If your es timates are accurate, and your insurer has made an error in processing your claim, you will need to file a claim appeal to ensure that you receive the appropriate benefits. (See Step Five for a discussion of the procedures involved in filing a claim appeal.)
It's essential to compare your estimate of the insurance company reimbursement with the actual reimbursement each time you receive an Explanation of Benefits Statement. It's sort of like balancing a checking account. You can probably get by without balancing your checking account for a while -- at least until the bank begins to charge you for overdrawn checks -- but you'll save a lot of money by balancing the account on a regular basis. In the same way, regularly comparing your estimates with the actual amount of reimbursement provided by your insurer is likely to lead to significant savings and to a better understanding of the policy rules.
You can maintain records of your medical claims in a notebook, on sheets of paper, or on index cards. If you have a computer, you can use a database program to record information about your health insurance claims, as well. In addition to recording basic information, it's also important to include a section called "Completed" on your record form. When you first create a record for a new claim, enter "no" in that section. When the claim has been paid in accordance with the policy rules, change the "no" to a "yes."
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