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Questions About the Language and Paperwork Involved with Health Insurance

Appendix A: Ten Frequently Asked Questions about Health Insurance Page 1

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Question 1:

I have a lot of medical bills. I send in a number of health insurance claims each year, and I receive letters and statements from my insurance company on a regular basis. However, many of the comments and explanations on those letters and statements don't make any sense to me. Why can't I understand what the insurance company is trying to say?

Answer:

There may be several factors involved. First, the phrases used by insurers in letters and explanations often represent computer-generated statements, not personal responses. Second, like most fields, the health insurance industry has developed a language of its own, including a series of technical terms. Until a better system of communication is developed, you may have to learn some of the technical language of the health insurance field in order to be able to understand the messages from your insurer.

Question 2:

I spend an enormous number of hours each year filling out health insurance forms, photocopying bills, maintaining records, and mailing claims to my insurer. Since I have health insurance coverage through both a primary and a secondary insurer, I have to go through that process twice. Why does there have to be so much paperwork involved in filing a health insurance claim?

Answer:

According to recent studies, the development of computers and electronic cards has eliminated the need for the enormous amount of paperwork that consumers need to deal with in filing health insurance claims. Replacing the current paper-based system of claim-filing and processing with a computerized, electronic system would eliminate the need for almost all of that paperwork.

An electronic system would also speed up the claim-filing process and save billions of dollars. In addition, a computerized, electronic claim-filing and processing system would eliminate the need for consumers to be involved in trying to deal with routine claim-processing problems.

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