Question

2. Margaret Silsbee, a patient of Fran Practon, MD, is seen on October 2010, for a pelvic examination. Although she has insurance, she pays cash for the visit and asks that you not bill the insurance company. The following month, her insurance company requests all of her medical records. State what you would do and why.

Answer 1

In current scenario, healthcare industry is very expensive because of the advancement in medical technologies and different modalities in treatment. This has resulted in use of Insurance policy for health issues. Certain policies are cashless where the patient need not pay cash bill during discharge whereas certain policies where the patient will pay the cash bill at the time of discharge. The paid bill amount cane be reimbursed within a period of 1 to 2 months. There are certain steps to be followed when insurance company requests for certain documents and medical records.

1. Discharge summary of the patient : This helps to get the brief report of the hospitalization and the reason for admission. It also state the health status of the patient on admission and discharge as well as the follow-up advise.
2. Download the claim form online: The claim form shall be filled by the admitted doctor as it also represents the details of the patient and the health complaints which what the patient got admitted. The form need to be signed by the doctor-in-charge of that patient.
3. Arrange all receipt of medicine/hospital bill in a chronological order : This adds further to the supporting documents as it includes the different categories of charges applied against patient it may be medicines indented or investigations raised or procedures performed/ room rent/ service charges/diet charges.
4. Take a copy of all the documents to be submitted : These are supporting documents and the hospital need to submit the copy of investigations done and clinical summary of patient in specific procedures as well as copy of discharge summary.
5. Thoroughly recheck the documents and dispatch them: Before submission , the complete documents shall be verified liaison officer of insurance department.

These process is essential to obtain the approval from insurance company as any deviations in the process can result in rejection in claim process.