My insurance company denied my claim. What should I do?
Get clarification. If you receive a rejection of coverage by the insurance company and the reason is not clear to you, telephone your insurance company for an explanation. There are many reasons a claim can be denied. They may simply need more information. For future reference, it is essential that you understand why a claim was denied. Be sure to document all calls with your insurance company. Get names and ask to speak with the supervisor. Be respectfully persistent!
What is meant by an EOB?
EOB stands for Explanation of Benefits and is provided by your insurance company. The EOB indicates the portion of the charge you will be responsible to pay. An EOB should be mailed to you prior to the company’s payment to the medical center. Believe it or not, you will be notified before Rush as to whether the claim will be paid or denied. Be sure to keep careful records of all EOB correspondence. Be sure to save all EOBs that you receive from the insurance company.
I paid my copayment for my visit. Why would there be a balance after the insurance company paid towards the cost of the visit?
The reality is that insurance companies frequently will not cover the entire cost of each medical service. Make sure you read your insurance brochure to clarify what is covered and what percent the insurance company will pay towards that service. The balance of the visit that is not covered by your insurance is your responsibility. An EOB will help you understand what was not covered. You will be expected to pay the amount specified. If you are unable to fulfill your financial obligation, you must contact our financial office.
Why does my account say payment is pending?
Pending means that a claim was filed with the insurance company but the insurance company hasn’t completed the claim. There can be many reasons a claim is pending. If more than 90 days has gone by and the case remains pending, a phone call to the insurance company should be made.
What forms of payment does Rush HTC accept?
You may pay by cash, personal check, MasterCard or Visa. Whenever paying by cash, always request a receipt from the attendant.
What does it mean to “max out” on insurance? What can I do about it?
Private health care coverage includes a lifetime maximum for coverage, up to a certain dollar amount. Patients “max out” when they reach that amount, and insurance coverage ends for that patient. You should call your insurance company one or more times a year to find out how close each patient is coming to reaching the maximum benefit. If the maximum us close, start searching for alternatives like Medicaid, Medicare or I-CHIP. Don’t wait until you max out.