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Guidelines for processing claims to private health company


11.07.2018 a las 07:01 hs 0 3 0

Generally, when we think about hiring a private health company, we do it according to the benefits that is supposed to have with regard to public health, so that at the time of need, when an event occurs count on the speed and effectiveness evitánd Onos those inappropriate and damaging waiting lists for diagnostic tests and others. However, the private health company has not proved to be the best remedy for this type of evil, as Trojan horses ride the health care being increasingly recurrent conflicts and claims that are processed for various causes.

When you are presented with a situation related to any disagreement or you feel that there is a breach by the health insurance Company, the first thing you have to keep in mind is the knowledge of each of the clauses contained in the Policy and thus to be certain of the guarantees that the company offers, as well as the limit of coverage, its restrictions, and the modalities that apply for the coverage, such as: health care, reimbursement and/or subsidy, which will allow you Determine with the highest degree of objectivity, how reasonable your arguments are when processing your claims.

As for health care, the insurance company presents a medical chart to the users of the service, covered by the policy, while when applying the modality of reimbursement can opt for another doctor who is not in the box and the company should To pay later that cost.

On the other hand, other health insurance companies also implement the subsidy, through which they give a contribution to the holder or beneficiary covered by the policy in case of disability or temporary illness.

Possible causes of denial of health care service:

Periods of lack: it is the period of time stipulated by some insurance companies in which still can not enjoy the benefit, is also known as "Waiting Time" in the case of pregnancy, usually eight months, does not apply to cases such as : Appendicitis, kidney problems, stomach cramps, and others that warrant an immediate intervention.

Irregularities determined in the health questionnaire, which verify that knowing the diagnosis is hidden pathology or incurred in ambiguous answers.

Non-compliance or delay in payment of premiums, or has ceased to cancel without informing the insurance company.

Medical malpractice: In this case the insurance companies are not responsible for this type of circumstances in which they consider that the person who must respond is the physician.

After corroborating that there are no weight arguments justifying denial of service, proceed to process your claims to the customer service (SAC) of the company. For this request the requirements, formats... Usually you fill out a form which carries your personal data; Name, address, date of birth, as well as insurance company information, policy number.

Provider data, physician data, expenses you have paid, (attaching detailed and orderly receipts that describe the type of service, cost per unit and total cost, must bear the insurance company code.

Submit your claim and save a copy set signed as received, which can be very useful in case you difficult your claim or become conflicting, better even if you send in digital email, because you can make a capture of the original , Excellent shipping evidence
Finally, he waits for the lapses established for this purpose by following him.

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