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Health Insurance (Expert Forum)
SIU procedures
This forum is for questions and support regarding health insurance issues such as Medicare, Medicaid, Long-term health insurance, COBRA, insurance portability.
SIU procedures
by unsurepat, May 14, 2009 02:06PM
Hello guys,
I had been outside the country (to my home country) and became sick during that time. I was admitted and charged a bill by the doctor. I did pay all the money and asked my insurance agency whether I could file a claim or not. They said I could definitely submit one. I went ahead and they mailed me the money which I had deposited. About a month or so later somebody from the SIU sent me a letter saying that they are reviiewing charges against me (because they feel that the charges are high - I have just sent whatever the doctor has billed me). They had asked for an explanation of benefits form which I filled out and sent to them. They came back to me asking for day-to-day reports and doctor details and I have diligently sent everything over. Still they wanted to investigate further and they have actually carried out investigations in my home country.
The investigation into the claim is still ongoing. Now my question is - I am not sure what the outcome of the investigation report will be (what processes do the SIU units follow). If they do determine that the charges are higher than what they are supposed to be (according to them) - how will the process go from there? I am very scared because I have never been involved in any kind of investigation before and I have nightmares about my insurance company deciding that this is some kind of a fraud (which this is not!!!) and just sending cops to my home.
I had been outside the country (to my home country) and became sick during that time. I was admitted and charged a bill by the doctor. I did pay all the money and asked my insurance agency whether I could file a claim or not. They said I could definitely submit one. I went ahead and they mailed me the money which I had deposited. About a month or so later somebody from the SIU sent me a letter saying that they are reviiewing charges against me (because they feel that the charges are high - I have just sent whatever the doctor has billed me). They had asked for an explanation of benefits form which I filled out and sent to them. They came back to me asking for day-to-day reports and doctor details and I have diligently sent everything over. Still they wanted to investigate further and they have actually carried out investigations in my home country.
The investigation into the claim is still ongoing. Now my question is - I am not sure what the outcome of the investigation report will be (what processes do the SIU units follow). If they do determine that the charges are higher than what they are supposed to be (according to them) - how will the process go from there? I am very scared because I have never been involved in any kind of investigation before and I have nightmares about my insurance company deciding that this is some kind of a fraud (which this is not!!!) and just sending cops to my home.
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