Blue Flower

The process of making medical claims from your health insurer may be quite hectic and regrettably, fail in the end. You do not want to undergo such frustrations especially when you are sick and trying to get the bills settled. Irrespective of the method you use to fill in the medical claim forms whether manual or electronic. All you need is to ensure that the process is smooth first and accurate. It is therefore advisable that when making claims, you must take into account finer details that you need to include in the claim forms to ensure it is not rejected by the insurance company. Here are a few issues you need to consider. Learn more about explanation of benefits medical claims,  go here. 


The insurance premium

There are various types of medical insurance premiums that are offered by insurance firms. The contributions towards the medical premiums vary. This means that a premium that attracts more monthly pay covers for more complicated health issues such inpatient care, surgery, and even external referrals. So, depending on your health conditions, find out whether you are claims from the right premiums. Find out for further details on how to catch medical billing errors right here. 


The maturity of the remittances

Before insurance companies can pay or reimburse medical claims, they must ensure that your claim is mature. That means that you must have attained the minimum period which is required for your contributions to mature. For example, it is not possible to make claims for inpatient services when you have just begun making the monthly contributions just a month ago.



When making medical claims, you need adequate evidence to support your claims. In fact, in some extreme cases like an accident, you may need the help of a personal injury lawyer to help you gather adequate and reasonable evidence to support your claims. Therefore, to ensure you claim is not rejected, look at the amount of supportive evidence you have.


Facility network

Insurance companies have specific hospitals that they prescribed for their subscriber. That means that claims can only be accepted from the hospitals that are listed with by the insurance company. You do not walk into any hospital or health facility the make a medical claim. Ensure that you are seeking medical care from the hospitals listed by your insurance company to make your claim valid.


Prevailing medical costs

Another reason that can lead to the rejection of your medical claim by your medical insurer is an overestimation of the medical charges. If you quote prices that are way about the prevailing health cost, you claim will be denied. To that effect, ensure that the claim you make is within the affordable limits. Take a look at this link  for more information.