Says Chapter 6 Some PMI insurers (and others recommend) that intended courses of treatment or surgery approved by them for policy coverage before costs are incurred. This process can often provide opportunity for the insurer to manage care provision or reduce after the event claim denials. What would be examples of after the event claim denials ? And how does insurer manage care provision ? Is this because of preauthorising / approving treatment provider ? Thanks very much
An after the event claim denial is where the policyholder has already had treatment, but the insurer refuses to pay. Managing care provision might be directing the claimant to a pre-approved hospital that it has a price agreement with and/or ensuring that the treatments being claimed for match the condition and its severity.
