How does medical insurance policy work - PowerPoint PPT Presentation

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How does medical insurance policy work

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Title: How does medical insurance policy work


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Medical Insurance Policy
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How Does medical insurance policy Work? The term
Medical insurance policy" is used when a person
carries more than one kind of health insurance.
Married people who work often face this kind of
situation. With the hopes of securing the most
adequate coverage, both the husband and wife
carry health insurance policies.
3
Unfortunately, this usually causes a lot of
confusion initially due to a lack of
coordination. With dual health insurance, each
company must agree to pay a claim in a certain
order. In other words, one health insurance
company must agree to pay the medical claim first
while the other health insurance company pays
second.
4
Dual health insurance companies must coordinate
in order to determine how a medical claim is
paid. One company must be a primary insurance
while the other is a secondary. The way this
process is initiated is by the person holding the
insurance. He must notify each company of the
existence of the other. After the initial
notification,
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each insurance company will review policy
language and other information to determine which
one is primary and secondary. In general, most
health insurance companies pay as primary for
medical claims submitted by the person who
initiated the insurance. So, for example, a man
who has Group Health through his work will submit
claims to them first and whatever is unpaid to
the insurance company of his spouse.
6
In order for dual health insurance to work, both
companies must agree with the payment arrangement
and the correct information needed to process a
medical claim. For the primary insurance company,
it must receive the original, itemized medical
bill. For the secondary insurance,
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the company must receive a copy of the original
bill along with an explanation of benefits
showing that the primary insurance has paid their
portion of the claim. It is a process that can be
messed up easily. So wise patients keep records
of any medical bills and explanation of benefits
for health services. They also keep their doctor
apprised of how their insurance companies pay.
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It is important to point out that carrying
medical insurance policy is not always
beneficial. Companies like Blue Cross will only
pay as a secondary if it feels the primary under
paid a medical claim. Therefore, it is important
to verify how a company pays as a secondary
before you pay for additional insurance because
you could end up paying money for
nothing. Source http//www.ehow.com/how-does_4569
459_dual-health-insurance-work.html
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10
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