Business
Do most of us really know how our health insurance works? How claims are processed. Who is likely to gain from our carelessness when looking over critical facts regarding our personal claims? It seems from my past experiences that most individuals do not realize their own claims truth and usually neglect what's really required by them to pay. Our Insurance Companies and Doctors love to gain from our negligence; consequently, they both can't wait to take advantage of some of us. I've found most of us hate dealing with issues when it comes to our health insurance. As a result, most of us just assume pay what our premiums call for
for it just seems easier than looking over our Explanation of Benefit copy.
Understanding our Explanation of Benefit forms is necessary. What is Explanation of Benefit (EOB)? Essentially it is a copy of how health insurance companies processes claims, furthermore, it shows what has been paid by us and our health insurance. Health Insurance Companies have guidelines of how they process their claims. Just to name one our claims are processed in accordance with AB1455 which is a set of regulations set by the Department of Managed Health Care.
To keep up with our regulations of HIPPAA here at work I cannot disclose to much information on a specific case; however, I can help many of us comprehend what goes on behind the doors of insurance company and Doctors offices.
Our health insurance companies' contract doctors, part of which, the doctor must submit they're claim within 120 days from the date of service. Since our doctor did not submit our claim within 120 days of service, the doctor should not be billing us for services. However, the doctor can submit an appeal to our health insurance company to show "good cause for delay". In the good cause for delay paper the physician must tell why in detail they did not submit our claim within a timely manner. Consequently, that is when Alternative Dispute Resolution comes...
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