Health Insurance Claims and Denials - Module 4 of 5


Question 1

A claim is a request for payment that a policyholder submits to her ________________ after she receives medical services.

Question 2

Which of the following WILL be included on a health insurance claim form?

Question 3

What is the most common legal issue that arises regarding a notice of claim?

Question 4

Whether a notice was “timely” is a factual question that turns on the circumstances of each case.

Question 5

Why is it important for a policyholder to provide her insurer with sufficient notice?

Question 6

Generally, _______________ is not considered ignorance that will excuse a holder from filing a timely notice

Question 7

What is the notice-prejudice rule?

Question 8

The misrepresentation made by a policyholder must be ________ in order to be considered fraudulent.

Question 9

Which of the following is a reason for an insurer to deny a policyholder’s claim?

Question 10

During _________ of an insurer’s denial of claim, _______________ will review and analyze the claim filed by the policyholder.