Claims reimbursem*nt – Why is it such a pain?
I have never met an insured person who enjoyed dealing with claims. It always is difficult and often a nightmare. Why is that so? Well, if you are covered with a short-term plan, medical underwriting is always done after the injury or illness. The insurance company needs to be double sure that the claim is not related to a pre-existing condition. Pre-existing conditions are not covered in short-term plans. If your claim is valid, you may wonder why they won’t accept your initial explanation as an honest explanation. Well, lying is endemic in our world, and insurance companies lose millions of dollars every year due to fraudulent claims. If they want to stay in business, they must check out every claim before they pay it.
If you are on a long-term plan, paying claims moves a little faster. The company already asked you many medical questions when you applied. Nevertheless, they will still research your claim to make sure your injury or illness was not related to a pre-existing condition you failed to reveal on your application.
Another problem is that clients often forget to calculate their deductibles and co-insurance when requesting a claims reimbursem*nt. As a result, the reimbursem*nt does not match their expectations. If the client has a $1,000 deductible and an 80/20 co-insurance plan with a medical bill of $10,000, he can only expect to be reimbursed $8,000. The client must pay the $1,000 deductible plus 20 percent of the first $5,000 (e.g., $1,000). Even though many international plans waive the co-insurance while overseas, co-insurance must be paid in the USA.
In a related matter, remember that you must pay your medical bills first and then be reimbursed by the insurance company. This is because American insurance companies do not have direct business relationships with medical providers outside the USA.
In order to have a happier experience when dealing with claims, keep copies of all medical bills/expenses you pay out in a special folder. Update this folder yearly. When making a claim, use your company’s claim form and send along copies of all your bills. Keep a detailed history of all your contacts with the insurance company: when you wrote them, who you talked with, what they said, etc. Be ready to wait at least six months to have your claims reimbursed. Remember that the claims department handles hundreds of claims every day. And their way of calculating your claims may be very different than yours. Ask them for an explanation when you are disappointed with the outcome. Overall, we have found the companies we work with to be fair although very careful when handling claims.
