How does a student insurance claim work?
Whether you are studying in the United States or traveling, the quality of a medical insurance plan can only be seen from claims and medical care. For most people, the claims process using U.S. student insurance is usually smooth.
But what if things don’t go as smoothly as you thought? What if, unfortunately, you do end up in the hospital and receive a ton of bills for medical bills from hospitals or clinics? Or maybe the claims process went smoothly but no compensation was received at the end (unreasonable in your opinion)? Also, what steps must be taken to apply for a claim to obtain a smooth, fast, and correct claim?
Here are five common claims problems and solutions for studying abroad in the United States:
I have submitted the claim information to the insurance company, but I have not received a reply after a long time. What should I do?
There are many reasons for not receiving a response from the insurance company, but the most common is that the claims information you submitted was never actually sent to the insurance company! To avoid this from happening, first of all, you need to contact the doctor, clinic, or hospital you are visiting to make sure they have submitted the required claims information for you to the correct insurance company.
If you don’t bring your insurance card on the day you see a doctor, chances are they won’t know to who to send the claims information. In this case, we recommend that you provide the medical provider with your policy number and the insurance company’s name and address (if you remember it). You can also tell them to scan your insurance card and send it to them when you get home. Doctors, clinics, or hospitals sometimes won’t help you submit claims information, in which case you need to send the information to the insurance company yourself.
Afterward, call the insurance company’s hotline on the card to confirm that they have received the claim information you submitted. By the way, ask them if they have any missing information or need to supplement and confirm with them that the information is correct. In many cases, insurance companies require you to fill out a Claim Form before processing a claim. It is recommended that you fill out this form and send it to the insurance company together with the bill for medical expenses.
If you feel that your English is not good enough and you don’t want to make a phone call (in fact, insurance companies generally have Chinese translations). Now it is generally possible to submit claims information online. Many insurance companies have launched an online claim settlement system so that customers can check the progress of their claims at any time. The online claim settlement system can tell you what information is missing and needs to be supplemented, which stage of your claim settlement, and your medical expenses coverage ratio. We strongly recommend that you use your student insurance plan’s online claims processing system (if available).
Tip: To expedite your claims process, we recommend emailing all claims information to the insurance company. This will give them immediate access to your relevant documents, and the time stamp on the email will let the insurance company know when you sent it (and you can prove when you provided it).
The claim has been processed for more than 30 working days but there is no news, why?
The average insurance company needs 30 working days to process a claim, but most claims can be completed in less than 30 working days. If it has been more than 30 working days and you have not heard from the insurance company, please call the insurance company to inquire about the status of your claim.
There are many reasons why it can take a long time to process a claim, for example, the insurance company is still waiting for your doctor, clinic, or hospital to provide medical bills or records. As each case has different reasons, the best solution is to go to the insurance company’s online claims process system to see what stage your claim is in or call them directly to ask if something is holding up your claim.
I do not understand the information on the claim explanation letter, who can I ask?
When the insurance company has processed your claim, you will receive an Explanation of Benefits (EOB) letter, which will explain in detail which of your medical expenses are covered and which are not covered. In addition, there will be a section in bold called Patient Responsibility, which will write how much the insured (you) will need to pay to the doctor, clinic, or hospital that you see. There are several reasons why the insured is required to pay expenses, the two most common are:
1. Out-of-pocket expenses such as deductibles, coinsurance ratios, etc. in the plan.
2. Your condition or treatment used is listed in the exclusions and is not covered.
What should you do if you receive a notice of outstanding charges or a payment notice from a medical institution?
Some providers will send you a Notice of Outstanding Expenses or a Payment Advice while your claim is being processed. Do not ignore these notices, the fees to be paid will not disappear on their own, and it is best to deal with them as soon as possible. But you don’t have to rush to pay the full amount to the medical institution immediately, because your claim process is still in progress, you should deal with it in the following ways:
First, call the doctor, hospital, or clinic (where you seek medical care) that treats you and let them know that you are filing a claim with your insurance company. Also make sure they have submitted all information (billing and medical records, etc.) to the insurance company and your correct personal information (name, insurance number, date of birth, etc.).
Also, check with them that they have the correct information about the insurance company, such as the insurance company name, claims address, and phone number. If everything is ok, then you should go to the insurance company’s online claim settlement system or contact the insurance company directly to check whether your claim case is in the system, when it entered the system, and whether there is any information that needs to be supplemented. At the same time, try asking when the insurance company will settle a claim with the hospital, doctor, or you. You can also check to see if you have any outstanding payments (deductibles in your plan, coinsurance percentage charges, etc.).
Finally, tell your medical provider about what your insurance company said, and let them know when the insurance company will file a claim with them and you should pay your outstanding balance right away.
Your claim was denied, but you don’t agree! Can I appeal?
If you are not satisfied with the reason for your claim denial or feel the denial was wrong. Don’t worry, all insurance companies let the insured appeal their claims. Many insurance companies simply require you to email the claims department and tell the case to be reviewed, while some require you to fill out an additional appeal form. During the appeal, you should provide all claim-related information to the insurance company to support your claim. Things like a doctor’s report, handwritten opinion, previous medical exams, or anything else that will make the insurance company feel like you have the right reasons for grievance. The appeal process takes about 30 days, and when the conclusion is reached, the insurance company will send you a detailed explanation of the outcome of the appeal.