Get Paid On Your Insurance Claim

When you have medical, home or auto insurance, you have a well-founded sense of security, knowing there won’t be any problems when you need it. Before the need arises, make sure you understand how to properly file a claim and receive the benefits to which you’re entitled.

The Claims Process – It’s Not Rocket Science
If you neglect to provide an important document, your provider is out-of-network, or your damage is considered an excluded event, your insurance carrier may not cover your losses. So, what can you do to be sure you’ll get paid on your claim?

Know what’s actually covered:

• Amount of deductibles
• Time limits to file a claim
• Length of claim process
• In-network or out-of-network providers (health care insurance)
• Out of network charges will cost you more

Understanding what kind of homeowners insurance policy you have can make a huge difference, when you file a claim. Picture this scenario: A meteorite crashes through the roof of your house and destroys your five-year-old television set. What happens when you file the claim depends on your policy:

• Replacement cost policy – pays to replace the old television with a new one
• Actual cash value policy – pays only a part of the cost of a new television due to depreciation

Be aware: Flood damage is not covered under standard homeowners and renters insurance policies – you must purchase separate flood coverage (available from the government’s National Flood Insurance Program and a few private insurers).
Also, most residential insurance policies do not cover earthquake damage – a separate earthquake policy is required.

Keep detailed documentation:
Back up your claim by maintaining thorough records of all forms of communications with your insurance company. This can be invaluable if you need to appeal a decision.

• Copies of mailed documents
• Phone conversation logs including:
• Dates of each call
• Name and title of the person you spoke with
• Information provided by the person you spoke with
•  Information provided by you
• Create a paper trail – follow up on each conversation
• Send a brief email to confirm what’s been agreed to and what still remains outstanding
• Keep receipts for all out-of-pocket expenses, e.g.,
• Hotel accommodations while your home is being repaired
• Towing charges to a body shop after an accident

Here are your options if your claim is denied and you still believe it should be covered:

If your auto insurer denies your claim
If your claim is denied or the insurance company refuses to pay as much as they should, there are several things you can do:

• Get another appraisal independently
• Ask for mediation
• If mediation isn’t successful, arbitration is the next action to take. You must hire an attorney to represent you, and the case is presented to a third party arbiter whose final decision is legally binding.

If your medical carrier denies your claim
1. Identify why your claim was denied
It may simply be a matter of some missing documentation.

2. Connect with patient advocates.
Many hospitals have social workers who help patients in dealing with healthcare insurance companies.

3. Resubmit your claim.
Insurance companies use auditing software (claim review programs) which can be different between insurers. This means the chances of denial or approval are not written in stone.

4. File everything electronically and keep records
Insurance companies use electronic-claim-filing software to identify specific issues to quickly produce a valid claim and check insurance companies’ denial formulas.

5. Learn the price of the treatment that you were denied.
It’s important to understand the reason for the denial. Usually, it’s the price of the procedure. By knowing the price of the procedure and the amount your insurer will cover, you can negotiate how much of the difference you will pay.

More information about health insurance claims

Your state insurance department has information about health insurance claim laws. Visit the National Association of Insurance Commissioners (NAIC) to access your state insurance department’s web site via “NAIC States & Jurisdictions” at www.naic.org.

Have you had problems with an insurance claim? Feel free to share your thoughts in the comments section below!