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[INFOGRAPHIC] All aboard the claim train!: Your express ticket to health insurance reimbursement

Going through the claims process can be either a chore or a real snap depending on the support you have access to. Check out this infographic that illustrates the benefits of having assistance from an insurance broker.

How to process insurance claims

Please click on the infographic above as it leads you along two different tracks with regards to getting your health insurance claims processed. With the top method – “The Broker Express” – you have the assistance of a dedicated insurance broker, such as the helpful professionals at Pacific Prime, to help you along with the task of being reimbursed for your medical bills.

The other path – “The ‘Go-It-Alone’ Line” – shows the extra stops that you will have to take if you decide that you will file your medical insurance claim with your insurer on your own. Without assistance from anyone, the infographic shows that there are several additional stops that you will have to go through before you get back the money that you would have already paid out-of-pocket. Let’s look at each individual stop along the way.

All tracks lead to…

Stop 1: At the moment you realize that you may be in need of medical treatment that will result in you making a claim on your health insurance policy. It is a wise idea to contact your insurer and/or broker to make sure that they are aware that a) they can expect that you will be making a claim soon and you may need additional assistance, and b) the treatment you receive may need pre-approval from the insurer in order for your claim to be accepted and reimbursed.

Stop 2: This is really the most important step with regards to your health, as it is when you actually get the treatment you need. Once you have been treated, you pay the bill, and then it’s time to begin the process of making your claim.

Only the lonely…

The following will be stops on the ‘Go-It-Alone’ Line, but if you have an insurance broker working for you behind the scenes, you will cruise right on past them without a worry.

Stop 3: Perhaps the most tedious parts of the whole process, gathering documents is a necessary step to make so that the insurance company can ensure that treatment has been administered effectively and payment for said treatment has been made. For this reason, before you submit your claim you must gather a completed claims form, invoices from the care provider, receipts from your payment to the care provider, medical reports showing diagnosis and treatment, lists of medications administered, and perhaps even more. Your insurer should outline all that will be required.

Stop 4:  Once you have all of your required documents, submit them to your insurer. No decisions about reimbursement will be made on the part of your insurer until all required documents are received. You can mail them in or drop them off at your insurer’s office in person, but many insurers today have online portals that can allow for electronic document submission over the computer. Some forms the insurer receives may need to be originals, though, so be sure of what exactly the insurance company needs before submitting documents.

Stop 5: Just because the insurance company has all the documents they asked for doesn’t mean the fun is over. The processing of your claim may take different amounts of time with different insurers, but it usually takes weeks. During this time, it’s prudent to check in with the insurer to make sure everything is progressing smoothly. Ultimately, this can have the effect of keeping somebody’s attention on your claim and helping to catch problems as they arise.

After stop 5, assuming your policy covers the treatment received and everything has been done correctly, you should receive reimbursement from the insurer in the form of a check or direct deposit to your bank account.

The difference is clear

From the stops outlined above, it’s easy to see why you would want to obtain your insurance through a broker. To be clear, this infographic only shows how a broker can help you with regards to the submission and processing of claims, but there are a whole host of other services that make using an insurance broker a clearly superior choice versus purchasing insurance directly from an insurance company. Other valuable service additions include:

  • Plan comparisons

  • Price quotes

  • Renewal assistance

  • Impartial advice

  • Administrative assistance

  • Insurer liaison

  • Policy analysis

  • Hospital information and recommendation

So what’s the catch? Believe it or not, absolutely nothing! Being insured through a broker like Pacific Prime adds an extra layer of services from an unbiased intermediary for absolutely no extra cost. Whether you get your insurance directly from an insurer or from a broker, the cost is the same. In fact, sometimes the established relationships that brokers have with insurance companies can allow for additional discounts that may not be found elsewhere.

To find out more about how Pacific Prime Insurance Brokers can make health insurance simpler and easier for you, contact us today or click the button below for a free online price quote.


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