Getting insurance coverage is a no-brainer these days. Sometimes you see, many insurance providers have changed their policies in recent years to try and create broader access to health care for people by tackling the high costs and complexity of getting individual health care coverage.
A job providing health benefits is one way to get health insurance coverage. But ever since the recession in 2008, many people have found themselves out of work and are not eligible for company-sponsored health care. At the same time, they don’t qualify for government-funded options.
While it hasn’t affected everybody, the unemployment rate has been high over the last few years that it’s no longer an anomaly for somebody to be out of work and need individual health care coverage. Here are some significant problems people usually experience while getting their self-employed health insurance claim.
It is one of the most common problems encountered by persons getting a health insurance claim. Getting a health insurance claim is not an easy subject. Imagine that you are applying for a job in a factory. Suppose you don’t have much experience, and the employment background check revealed that you had had no previous job experience in the related field. It is more likely to happen if you are getting individual health care coverage and not from your employer.
Delays also occur more frequently in obtaining individual health insurance coverage than if you are part of a group plan through an employer. With an employer’s group plan, there is usually a set time period for when a claim will be paid.
- Producer Not Under the Policy
Another problem people usually experience is when the insurance provider says it’s not responsible for paying a claim even though it is covered under the specific policy. If you are buying health insurance for your family, read all the details so that you know what is covered and what isn’t. If you don’t understand something, call the customer service line and have them explain it to you.
- Premium Not Covered
Most health insurance policies provide for a certain number of claims within a specific time period but allow for a small number of additional claims beyond that time. So as long as you stay within the limit of your deductible, you pay nothing out-of-pocket. But make one premium payment late, and you’re off the hook for that claim as a courtesy from the health insurance company.
- Incorrect Deductible
Most deductibles should be fixed amounts. But some policies have deductible amounts that are calculated on a percentage of the total claim amount. For instance, your policy may require a $5,000 deductible per year, but instead of applying it to all of your medical expenses in a given year, they use it just to 50% of each claim you submit.
With some policies, you can apply for short-term health insurance if you have a sudden accident or illness and then apply for a long-term policy at the end of that short-term policy. But some insurers count those two consecutive policies as one continuous policy, which means you might eventually be denied coverage if you make one claim too many.
- Missing Medical Information
Some insurers don’t want to pay your claims for reasons that may or may not be under your control. For example, they ask for proof of your medical expenses but won’t pay claims until they receive a doctor’s report or similar document.
- Delayed Payment
Some insurers won’t pay your claim until they recheck the number of your expenses and make sure you didn’t lie about them. For instance, some insurers will ask you to submit receipts showing that you purchased certain products to get paid for a claim. Sometimes, this will delay the payment by several weeks.
Some insurance providers will ensure that you have health and dental insurance coverage for your family. Although it is relatively easy for some people to get health care coverage, getting it can still be a challenge in individual medical insurance plans, especially when economic and governance problems are happening around the country. Make sure you stay focused and gain a proper understanding of health insurance without facing any problem that occurs while claiming it.