Tips to Show the Workings of Health Insurance Companies – Part company

When people have health insurance they expect that their treatment bills will all be taken care of. But what goes on behind the scenes? Well, medical services billing is usually done by an outside company as is physicians billing.What normally happens is that the patient goes to get treatment or a check up. Their history and ailments are then given a specific code so that a form can be filled in for submission to the insurance company, by the third part company, who will end up paying for whatever procedure is necessary.Once the forms have been submitted to the insurance company, they will have their own experts peruse the paperwork to evaluate the claim. This is sometimes contentious since some insurance companies do not want to pay for unnecessary procedures, or rather, what they themselves consider to be unnecessary procedures.Once the claim has been approved, the insurance company will pay a percentage of the claim, as discussed with the service provider at an earlier stage. If the claim is not passed however, the insurer will notify the health care facility who will rewrite the claim in the format that the insurer wants. Perhaps they were claiming for services not covered by the scheme that the patient has so this has to be altered until the insurer is satisfied.This cycle of resubmitting claims can go on for some time until either the insurer is satisfied, or the provider of the hospital facilities decide to accept a discounted rate for the service that they provided.As this service tends to take forever to finalize, the third party company really takes a load off the hospital or doctor. Without the use of these third party companies, this whole system would surely grind to a halt and no one would get paid at all.The amount of times that these forms are passed around can reach the ridiculous stage. Insurance companies are renowned for not wanting to pay a cent that they do not have to. This is why there are so many bad headlines appearing in the press at regular intervals. However, they do have their place in society and save a lot of people from horrendous problems when they have accidents and such.These days, a lot of this work is carried out electronically. It has become necessary for the provider to check on the identity of the patient through electronic means since they could end up treating someone other than the right person. If the insurance even suspected that they had made a mistake, then no payment would be paid.Although this procedure has been explained briefly here, it is rather a complex procedure with many levels to pass through before the provider actually gets paid. Some providers who use systems like Medicare still insist on sending forms manually instead of electronically. This had ended up being the bottle neck in the whole system since it requires many more people to do manual checks on forms than if it was all computerized.