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A Systematic Summary to Dealing with Health Insurance

Part 1: The Basic Tools, Chapter 3: Developing a Systematic Approach to Dealing with Health Insurance Page 25

Continued from Previous Page


In order to obtain maximum benefits from your health insurance policy, it's essential to develop a systematic approach to dealing with health insurance claims. The six-step approach suggested in this chapter includes

  • selling up an information file;
  • using the predetermination of benefits process;
  • establishing an efficient claim-filing system;
  • selling up an effective record keeping system;
  • developing a method for filing claim appeals with your in surer;
  • establishing a system for requesting help from private organizations and state or federal agencies.

In many cases, following those steps will help to prevent health insurance problems from occurring, or will help to quickly resolve those problems that do occur. However, if those steps do not lead to a resolution of a specific problem, you can request help from a private medical claim-processing company, the state or local medical society, an attorney, or your state or federal legislative representatives.

Although some people may feel anxious about questioning the decisions of an insurance company -- or of any large organization -- filing appeals when appropriate is essential to making certain that you obtain the health insurance benefits to which you're entitled. As long as a claim appeal is presented in a calm, reasonable way, insurers will generally respond in a similar manner, thus allowing the problem to be resolved.

Once you've understood the technical terms and phrases used in the health insurance field and the overall structure of the current system, and once you've developed a systematic approach to dealing with claims, you have the basic tools you need to deal effectively with your health insurance problems.

Continue to Part II

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