How Indemnity Claims Are Processed?
Normally, when you are on an indemnity policy, you will pay the doctor or provider of service at the time you receive the service (“fee-for-service”). It is then your responsibility to submit any proof of payments to the insurance company to receive reimbursement. The insurance company will review the claim taking into account: The services being billed are covered on your policy The amount of deductible you are responsible for (or have already applied to your benefits), The coinsurance you are responsible for, What the usual, customary and reasonable charges are for the services being billed, Whether or not you have met your maximum out of pocket limit for the calendar year. Once the claim is reviewed the insurance company will then reimburse you the appropriate amount.
