HSEM 255 Study Guide - Comprehensive Final Exam Guide - Primary Care, Medicaid, Health Insurance
20 Nov 2018
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Dental/vision insurance can be bought separately and added to insurance plans. Elective surgical procedures usually excluded from medical or health insurance, those that are not considered necessary from a medical perspective and having them performed is the individual"s choice ex. vision surgery. That the provider the at refers to does only nonexperimental procedures. That they will accept the ucr fee as payment for all services. If the procedure is considered experimental, at consults a representative of the insurance company before referral. Find out the reasons that the claim was denied (law requires insurance companies to have this information) Obtain a statement from the physician or other health care provider explaining why the treatment was implemented and justifying the fee. If the self-insurance fund of a parent"s employer covers a patient, correspond with the employer directly. The employer has final legal authority to reverse the denial.
