Many people do not fully understand the full coverage of most individual health insurance plans.
Thus, it is not surprising that there are many disputes, disagreements, and issues regarding claims from medical insurance policies.
Your broker or agent may have forgotten to discuss certain provisions and terms in the contract.
However, you could still not make claims if the insurance contract says you could not.
Ignorance about specific terms and provisions would not be an acceptable excuse.
How could you possibly avoid any form of trouble that may arise from filing claims from individual health insurance plans you own? Before you sign any document and agree to purchase a policy, it would be better if you would observe the following measures.
Read all the items and statements stipulated in the health insurance policy document.
It is assumed that once you sign the documents, you have understood all the terms and stipulations.
The same goes for individual health insurance plans.
Scrutinize all documents involved.
Know all exclusions the insurance product may contain.
Not all health care insurance products are covering all illnesses and conditions.
Some sicknesses and conditions may be covered while others are not.
Know and agree with all exclusions before buying the insurance product.
You could not possibly get claims if you have been hospitalized because of a medical condition not specifically identified in your policy coverage.
Keep the third-party administrator in the loop.
You could inform your TPA in advance or before your hospitalization.
It is possible to claim advanced claims at least within 48 hours prior to admission.
You could also clarify with the TPA all procedures and requirements the policy may have.
Get hold of all necessary documents.
Collect diagnostic reports, discharge summaries, and medical advices for post-hospitalization period, including copies of bills and cash receipts coming from the hospital.
Verify duly completed hospital bills before signing.
Take note that erroneous entries in the bills could possibly forfeit the insurance claims in the future.
Closely scrutinize the clause of the individual health insurance plans.
This states that only costs that have been necessarily would be possibly reimbursed.
For instance, if you have received a medical treatment costing $1,000 and the same treatment is offered by other doctors or hospitals at $500, expect the TPA to sanction that claim to only $500 instead of $1,000.
Be honest in declaring all your preexisting illnesses.
This could help make sure there would not be any serious problem regarding future claims.
TPAs would always know and discover whether you have been honest or not in your declared preexisting medical conditions.