What Does “Proof of Payment” Mean on My Claim Form?
Hi Steve, Thanks for the help you are giving with Max’s claim, very much appreciated. It’s been very difficult to say the least. Their strategy seems to be to make it as difficult as possible to avoid paying a claim. We put together very specific and detailed information for Max’s medical claim and it’s like they are finding other things they need to see just to delay it longer. Things like not accepting a payment confirmation receipt from a provider as proof of payment but making us go back and find the corresponding credit card charge on the statement, or asking the hospital to provide a “current” bill which hasn’t changed since they issued the original bill when Max was discharged back in April. All they should have to do is loop in the Hospital biller for confirmation that the balance is still outstanding and to confirm the amount. Scott
Hi Scott, Thanks for send me this regarding Max’s claim.
I’m not the Insurance Company and I cannot predetermine claims. However, hopefully, I’ll be able to help you understand why they are asking for these items.
Insurance companies are regulated by the States they do business in. Part of the many rules that they have to follow is how they process claims. When a company is asking for specific information, one reason they are doing this to meet their reporting requirements.
Before God gave me the idea to start TripInsuranceStore.com, I was a Certified Financial Planner with a lot more Securities and Insurance licenses.
One day I was touring an insurance company I worked with and there were stacks of files everywhere in their admin area. They told me they were getting their multi-day annual audit of Disability and Health Insurance claims from their State’s Insurance Dept. The auditors picked out 350 claim files and for each claim they examine every document for this information:
- Were all the procedures followed?
- Were the correct State-approved forms completed and signed by the Insured?
- Did the Insured submit all the supporting documentation?
- Was the claim underpaid, overpaid or correctly paid?
You stated: “Things like not accepting a payment confirmation receipt from a provider as proof of payment but making us go back and find the corresponding credit card charge on the statement”.
The reason they want to see the charge on your credit card statement is because a payment confirmation receipt does not show who paid the money and in what form the money was paid. For example, if you had a $500 courtesy credit from your travel supplier that was applied to your payment, that $500 credit isn’t insurable. Without seeing your credit card statement, the insurance company has no idea how much you actually paid out of pocket.
As for “asking the hospital to provide a current bill”, many times costs are added on later as the providers submit their invoices. The insurance company wants to be sure that you aren’t being underpaid.
As you know, we help our customers with their claims. Its common for previously unknown important information to show up weeks or months after a claim was started because of various delays.
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