Types of Health Insurance Claims

Most health insurance plans have different types of claims for the insured. For instance, under a preferred provider organization (PPO) scheme, you can get treatment from any health care provider, and the insurance policy will cover the expenses. Under a health maintenance organization (HMO) plan, the insurance companies will cover expenses only if treatment comes from certain doctors, hospitals and clinics that are specified in the policy.

With a group health insurance plan, individuals in a group can apply for claims for their expenses in the event of any health problem. With long-term-care insurance, unlike other plans, the insured can claim reimbursement for treatment of any prolonged illness, degenerative condition or cognitive disorder, or other similar disabilities.

With flexible spending accounts in a health insurance policy, the insurance holder can use pretax dollars for treatment of certain specific medical costs and related expenses. With a health reimbursement arrangement, the insured can claim for reimbursement of certain portions of treatment expenses for any family members. Health savings accounts enable the insured to save and invest money for medical expenses, and they have tax advantages.

Whatever the claim type, the insured will need to furnish certain documents to the insurer. These documents may include the details of the policy, a filled-out claim form and treatment bills, including those from tests and rehabilitation prescribed by the doctor. You may also need to describe the nature of the ailment that required treatment or submit other documentation of medical expenses. These documents will assist the insurance companies in processing the claims and help rule out the possibility of fraudulent and false claims.