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  4.  » What do I do if my health insurance claim is delayed?

What do I do if my health insurance claim is delayed?

| Apr 14, 2021 | delayed and denied insurance claims | 0 comments

Medical care out-of-pocket is expensive, which is why most Texas residents pay for health insurance to cover the majority of their cost. When they pay for a procedure, most people expect to be reimbursed by their insurance company. Unfortunately, some people have to wait for months before their claims are decided upon. As a result, the policyholder’s financial stability is affected, as is their ability to continue to receive medical care.

Why is my claim delayed?

One of the most common reasons a claim can be delayed is because the insurer is investigating the claim to determine whether it is in the scope of the policy. It could also be delayed because of miscommunication—information between different departments does not always flow swiftly, as each probably has its own billing codes and procedures. However, policyholders should try to find out why the claim is getting delayed in the first place.

Documentation is important

All phone conversations, emails, and mails should be recorded. This documentation should include the date and time of the correspondence, the people with whom one has spoken and the matter discussed. Policyholders should also ask for follow-up emails or confirmations through email as much as possible.

Finding out the final decision with regards to one’s health insurance claim is essential to moving forward, as it is possible to file an appeal for a denied claim. But without a decision, uncertainty and frustration can prevail. Filing an accurate claim in the first place can avoid delays, which is why consulting an experienced attorney for guidance may be beneficial.