Health Insurance Claims FAQ
- How long does it take to process a claim?
If the policy has been in force for longer than two years, it is considered “Incontestable,” which means it will be paid as soon as all of the required documents are received and examined.
If the policy has been in force less than two years, it is considered “Contestable” and will be subject to further review, which could increase the processing time.
- Once my claim has been processed, how long will it take to receive my check?
Typically, you will receive your check within 10 - 15 business days from the time your claim was processed. If you haven’t received your check within 30 days of the date your claim was processed, please contact our Customer Service Department.
- My policy has been in force less than two years, how can I expedite the processing time for my claim?
The process can be expedited by providing itemized medical billing statements and completing all necessary portions of the claim form, including listing on the Claimant Statement all known medical providers who treated the insured in the last 4 years.
- Why do we request additional information on claims that are less than two years old?
As with most insurance companies, claims submitted on policies that have been in effect less than two years require a more detailed examination.
- What is the difference between a UB-04 and a
A UB-04 is typically a summary associated with hospital stays. A CMS 1500 is normally associated with clinic or physician visits.
- Why do we require both a UB-04 and itemized medical billing statements?
The UB-04 has information on it that is not always on the itemized medical billings or other summaries, i.e. diagnosis and procedural codes.
- Why is additional verification via medical narratives (Doctor’s Notes) requested on accident claims?
Many times the UB-04 or CMS 1500 will include diagnosis codes; however, these codes are not always fully descriptive of why the visit to the ER or physician took place. Narratives from those visits are helpful as they go into more detail of the observations and conversations that took place during the diagnosis and treatment of the injury. You can request a copy from the treatment facility.