Maryland Life and Health Insurance License Practice Exam

When a claim is submitted for medical expenses, how does an insurer address past-due amounts?

1. By adding interest to the overdue amount

2. By deducting the overdue amount from the claim payment

3. By rejecting the claim altogether

4. By requiring additional documentation

The correct answer is: By deducting the overdue amount from the claim payment

When an insurer addresses past-due amounts in relation to a claim for medical expenses, they typically handle this by deducting the overdue amount from the claim payment. This approach is based on the understanding that the insurer will only pay for the covered expenses that are current and within the scope of the policy. By deducting past-due amounts, the insurer ensures that they are effectively managing the risk and liability associated with outstanding payments. This method also emphasizes the importance of timely payments and helps maintain the integrity of the insurance process. It prevents the possibility of overpayment for services that might already be owed to providers, reinforcing the need for policyholders to remain up-to-date with their financial responsibilities to healthcare providers. In doing so, the insurer can accurately process the claim while adhering to the terms and conditions outlined in the insurance policy.