Fraud has many direct and indirect effects on insurers and policyholders. Insurance frauds can lead to increased social and moral risks through the behavior of policyholders and people involved, which in the long run, imposes a budget deficit and a heavy financial burden on the insurance industry. Insurers’ fraud seriously threatens the dental insurance industry’s growth, development, and profitability, which will destroy the atmosphere of trust and transparency by questioning the principle of good faith.
With fraud in the insurance industry, the provision of services to the target community may be limited, and the satisfaction of the insured and insurance beneficiaries may decrease.
What is an insurance claim?
An insurance claim is a formal request from an insurance provider to reimburse damages covered by an insurance policy. Insurance is a financial contract between the insured and the insurer. The insured pays a fixed premium, and the company is obliged to cover the costs at the time of damage.
When you have an accident that the insurance covers, the insured must file a claim and describe the incident, the goal is to report the incident to the insurance company to receive compensation.
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How does a dental insurance claim work?
The insurance claim is a safety net that can be relied upon when accidents occur and damages are incurred. Unforeseen expenses such as medical emergencies and accidents cause great economic shocks to families; because they are unaware of their occurrence and may not be prepared to deal with them. In this situation, the dental insurance claim can be compensatory to some extent.
Insurance payouts can cover medical expenses, replace income after retirement, and help families cope in times of need. Insurance specifically allows people financially dependent on their families to have a source of income in the event of their financial loss.
Processing a claim includes the following steps:
- You should submit a report to the policyholder when an unfortunate event occurs. When you need to pay for treatment, you must prove to the insurance company that something happened to you by providing evidence. This process is known as making a claim.
- Application registration includes filling out claim forms on the insurance company’s website or the policyholder’s office.
- To prove that your claim is valid, you must provide documentation of the incident.
- The insurer will check all the documents you provided to prove the validity of your claim.
- The insurer will approve the claim if it meets the terms and conditions stated in your insurance policy.
- After approval, the insurance company will pay the benefits specified in your policy document. For people who have life insurance, the payment goes to the beneficiary.
- The insurer may provide a lump sum or break the payment down into regular payments based on the terms of your policy.
- The amount of time insurers spend verifying and paying the insurance amount varies from case to case. If the documents are in order, the settlement of the claim takes only a few days. Before purchasing insurance, you should check the insurer’s creditworthiness and customer service history to ensure that claims are paid without delay in an emergency.
However, when buying insurance, you should disclose all the details about your health and lifestyle habits to your insurer. The insurer can deny your policy claims if you decline or misrepresent any fact.
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StrAIberry solution for dental insurance
StrAIberry has been developed to improve the quality of oral and dental health in the community to help people with regular and continuous care. However, the primary value created in StrAIberry is cooperation with insurance companies.
StrAIberry cooperates with insurance companies
- Before signing the contract, the insurance officials hold a meeting with StrAIberry and inform them of the priorities and services they provide.
- StrAIberry designs a dedicated dashboard for each insurance company to cover and provide users with all the services it offers.
- After StrAIberry’s cooperation with the insurance company is finalized, all people covered by insurance must install the StrAIberry app and create their accounts.
- After registering in StrAIberry, each user’s personal information is written in the application. People enter their oral and dental care routine, perform free dental check-ups on StrAIberry and see the results; if they have taken radiographs during their treatment process, they upload them in the app and the special section. This way, a complete description of each user’s state of mouth and teeth is recorded in their user profile.
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The insurance company has a complete record of all its users on its dashboard, and they can see all the problems with their teeth and the treatments. This will prevent financial loss to the company. When a user applies for insurance for a specific treatment, the insurer can check the user’s profile to ensure the user’s claim is correct. The dashboard that StrAIberry has designed for insurance companies makes it possible to handle users’ claims automatically and prevent fraud.