Claiming Health Insurance 101
The first step in receiving health insurance benefits is you or your doctor files a claim with your insurance provider. If the doctor is in your insurance plan’s network, the doctor’s office will usually file the claim electronically on your behalf. If your doctor is outside of your insurance plan’s network, you may have to file the claim yourself.
Understanding the basic
It is important to get an itemized bill from your medical provider and all the billing receipts before you file your claim. The itemized bill will list all services rendered by your doctor and the cost of those services. It is advisable to make sure your medications are clearly listed in the itemized costs.
Key information that you need to provide on the claim form includes:
Your insurance policy number, member number, or group plan number.
Whether you received the services yourself or if they were provided to a dependent or spouse.
Whether you have dual coverage or co-insurance.
Your reason for visiting the doctor.
5 steps to claim your health insurance benefits
If you have to file your own paperwork, the best place to start is to visit your insurer’s website. Many insurance companies allow insured individuals to log in to their health insurance plan portal online. Ask your employer if your workplace health plan provides this option. If you have a private health care plan that is not provided by your employer, contact the insurance company directly to find out how you can access its services online and help you set it up. However, the insurance claim process typically involves five main stages, from the moment you report your loss to the resolution of your claim.
Step 1 : Connect with your broker
Your broker is your primary contact when it comes to your insurance policy – they should understand your situation and how to proceed. Once you give your broker a detailed list of all the items that were damaged or lost, and any photos or videos that help to explain the circumstances, an adjuster will follow up with you to continue the claims process.
Step 2 : Claim investigation begins
After the claim has been reported, it will need to be investigated by an adjuster to determine the amount of loss or damages covered by your insurance policy. The adjuster will also identify any liable parties, and you can help the process by providing any witness information or other parties’ contact information.
Step 3 : Your policy is reviewed
Once the investigation is complete, the adjuster will go through your policy carefully to determine what is and isn’t covered under your policy, and inform you of any applicable deductibles that may apply to your case.
Step 4 : Damage evaluation is conducted
In order to accurately evaluate the extent of the damage, your insurance adjuster may hire appraisers, engineers, or contractors to lend their expert advice. Once the evaluation is complete, your adjuster will provide you with a list of preferred vendors to help with repairs. You’re not obligated to hire these vendors, but it can save you a good deal of time and research.
Step 5 : Payment is arranged
After repairs have been completed and lost or damaged items have been replaced, your adjuster will contact you regarding settlement of your claim and payment. The amount of time it takes to receive payment will depend on the complexity and severity of your situation.
Because your health is our priority
From giving a smooth and easy access to a dedicated medical network on a cashless basis, to provide your member with a local assistance, allowing face to face meetings, visits on sites, we will provide you with full peace of mind thanks to our professional and personalized approach.
We are good at claiming your health insurance benefits worldwide
Youna International Health Solutions has grown with the industry to offer strategic, sophisticated approaches to manage your medical benefits, while maintaining emphasis on outstanding service and attention to the unique needs of our members thanks to :
📇 Claims adjudication and payment
🏥 Medical case management
💳 Network access on cashless basis
🗃 Full back office support and service
🧰 Cost containment tools and negotiation with medical providers
🛎Customer service hotline support
🔐 Anti-fraud tools
🚁 On site visits
