These are the steps taken:
- Providers will submit the claim.
- Insurance carrier will request your medical records pertaining to your current plan and past history.
- Insurance sends documents to their medical review board.
- Documents will be assessed.
- Decision will be made based on records received if your treatment meets the criteria of Medical Necessity.
It’s important to remember that what you or your doctor defines as medically necessary may not be consistent with your health plan’s coverage rules. Before you have any procedure, especially one that is potentially expensive, review your benefits handbook to make sure it is covered.
To Avoid Unwanted Healthcare Billing
Surprises, be sure to ALWAYS:
• Ask your insurance company what costs you
must pay out of pocket for your doctor visit,
test, procedure, or surgery.
• Bring your most up-to-date insurance
card(s) to every doctor appointment
and health care visit.
