Invoice and Charges Verification:

The insurer checks the medical charges against the standard rates for the procedure or treatment to ensure the amounts are reasonable and in line with usual and customary fees for that medical service.

Duplicate Claims Check:

The insurer checks if the same expenses have been submitted for reimbursement by another party or if the same claim has been filed multiple times.

Third-Party Verification:

In some cases, the insurer may contact the healthcare provider directly to verify the authenticity of the invoices, medical services rendered, and if the charges match the treatment provided.

Request for More Documentation:

If any discrepancies or uncertainties arise during the investigation, the insurer may request additional documentation or clarification from the insured or healthcare provider. This could include:

More detailed medical records or reports.

An explanation for any inconsistencies or irregularities found in the original claim.

Missing receipts or additional invoices.

Verification of Co-Payment or Deductible:

The insurer may also check that the co-payment, deductibles, and any other out-of-pocket expenses have been properly accounted for in the claim.