Wat is the act of determining whether treatment is covered under an individual's health insurance policy is?

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cormeisha p

Wat is the act of determining whether treatment is covered under an individual's health insurance policy is?

Lori S

Prior to offering the policy it is underwriting.

After the policy is in effect it might be called pre-certification.

Don

pre-authorization.
Don
http://mtnhealthinsurance.com

Apples to Apples

I think it's called pre-qualification.

santobugito

call the insurance company and ask

Insurance Pickle.com

Submitting a claim.

mbacon101

Get out your insurance card and dial the 1-800 number for PATIENT not provider.

Listen to the menu:

If it is voice answerable say "Customer Service" or "Operator" . If it is not, try to navigate to Customer Service (Usually key words are "Other Inquiries" and of course "To speak to a customer service rep...") If you can't find it try pressing 0, or *0, or press wrong number repeatedly and sometimes the automated system will direct your call. Sometimes this takes awhile and you will be on hold. The representative will ask you for your birthday, name, ID or social security number to verify, and tell you the call is recorded.

And then ask whether treatment is covered. (If it is, ask for the percentage of coverage, whether there is a waiting period (sometimes major services require 6 months after your get new insurance to be covered), and if the deductible must be met before treatment can be covered).

Remember to get their name...sometimes they screw up then you would need to talk to a supervisor)

Good luck.

Donna <><

Pre-registration or prequalification

â™¥â™¥The Queen Has Spokenâ™¥â™¥

It's how it is worded in the policy what kind of policy it.

If it's a HMO you are limited to who you can go to. usually only a list of their providers. For any doctors of specialty's you would have to have clearance from the insurance company by having your primary doctor refer you.

Covered drugs may be restricted to older cheaper drugs.

In a PPO you can usually go to any doctor you want. Drugs may on a tiered payment. Usually offering you three months on prescriptions by an agreement with a mail order supplier. Most procedures will be payed at the rate agree upon by the policy.

Generally there is a co pay you are required to pay by for doctor calls and drugs. And a deductible before they will start paying on anything.

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