Simplify the medical claims process

5 tips employees can use right now

Here are five things that your employees can do to help simplify the claims process: 

#1 Know your coverage

Make the most of your healthcare dollars by doing your homework before an appointment – for example, calling the carrier to make sure services are covered.

#2 Understand the difference between “in-network” versus “out-of-network”

Insurance plans generally negotiate lower rates with “in-network” providers. Going to outside providers may mean big out-of-pocket expenses.

#3 Take good notes

When speaking with a provider or insurance carrier, be sure to document the conversation for reference if questions arise.

#4 Complete and return all forms ASAP

Visit carrier websites for the necessary claim forms and fill them out completely to avoid delays in processing time.

#5 Claim denied? File an appeal

Two common reasons insurers deny claims are: coding errors and lack of pre-authorization. If a claim is denied, call the healthcare provider and carrier as soon as you receive their statement of benefits. Approval may be as simple as your provider resubmitting the necessary information.

Medical claims, minus the headaches

When it comes to employee health coverage, Automatic Data Processing Insurance Agency, Inc. (ADPIA®) knows that you want to focus on your business – not the claims process. Count on us to help guide you and your employees through the benefits process.

 If you have questions, we’ll help you get answers. Contact us.