Question

Reviewing the definition Third-Party Payer will also assist you in completing this assignment.

1. List 3 types of third party plans?

2. What information is required to file a third-party claim?

3. What are the steps for filing a third-party claim?

Answer 1

1. Third party payers are who carry insurances for public,private and managed care that should provide the reimburse fully of the cost of the healthcare provider services.The healthcare providers are hospitals,doctors,pharmacists and those caring for the patients.

Types of third party plans:

• Health plan:This third party plan works at the time of claiming the health insurance in that patient will come under first party,hospital will be second party and insurance claim company under third party that pays medical expenses to the hospital.This is mainly depend on the insurance company.If the company is self insurance the employee pay the medical bills from the company funds account.The company pays directly to the patient for further treatment process.
• Accident insurance plan:In these plan the the insurance company is under second party and the motorist in the accident will be the third party.The motorist will deal insurance company to avoid the increasing cot of the policy.These plan procedure become more longer because company will delay the process for giving payment.
• Business liability plan:It is very important for the business head to purchase a business liability plan to protect themselves if any accident takes place in the working area.For examples if the customer falls and had a injuries with in the company premises then the insurance claim covers the third party payer for their medical cost.They also include for legal cost against the harassment.

Third party payers:

• Health maintenance organizations that may combine with health insurance company to keep their cost in low range.
• Preferred provider organizations will include the health care providers and insurances but the patients include ore expense if that go above the network.
• Health insurance exchange provide an opportunity to purchase insurance for the patient self employed to increase preventative healthcare.

2. Information required for third party claim:

• Details of the vehicle involved in an accident and treatment of the patient for the insurance claim.
• Fill an FIR stating the details of the accident and information about the vehicle driver and witness of the person at the time of accident.
• As per the motor vehicle act,for compensation of vehicle with respect to any loss of property and injured person in an accident such cases are reported under the motor accident claim tribunals.
• Motor Vehicle claim tribunals issue a report upon the application of the insured person to hold the inquiry to the claim.
• Document of the claimant who suffered loss in the accident.
• The treatment record and medical bills of the injured person.Income certificate or age proof of the injured person

3.Steps for filing of third party claim:

Step 1:Collect the itemized receipts:To file a claim to obtain the receipt or bill of the item involved in the incident from the medical provider and bill will attached along with the code of the insurance company to pay for your claim.Bills should contain full name and date of service

Step 2: Complete Claim Form:Claim form is a document that contain all the details of the accident or illness that help to determine the expenses.Read carefully before filling the form if any question contact insurance company.

Form contain:

• Personal information like name, address etc
• Insurance information such as policy.
• Provider information including physician name.
• Other expenses that you paid

Step 3:Make extra Copy:It is good idea to make copies of your claim before sending to the insurance company

Step 4:Review and send: Review all the document before sending to the insurance company without any mistakes and be sure to ask any additional documents to claim plan.For fast process submit all you documents by email or fax.

Step 5:Wait for response: Wait for the claim date.If you don't receive payment with in time contact insurance company for further problems with in claim.