Tips for filing a claim health insurance

Health insurance

Health insurance is one of the insurance products that specifically guarantees for health care or the care of the members of such insurance if they fall ill or have an accident. Understanding tips filing health insurance claims to prevent unnecessary hassles and increase your chances of getting a replacement. There are things you need to do when asking health insurance.

How to submission of health insurance

1. Read certificate / your insurance policy; Before undergoing treatment at the hospital, learned all the provisions of the policy benefits. If you are a collection of health insurance, you are usually given a list of benefits of the policy. You can also ask the personnel to know the limits of the policy benefits according to the parent company. For your individual policy holder, you can ask the agency and part of the ministry claims your health insurance company.

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The things you need to know from a certificate and your policy:

  • The benefits of health insurance are paid, the maximum limit for each item of treatment and rest limits you have
  • Exceptions, the type of disease or what treatment methods are excluded, such as congenital disorders, cosmetic surgery, disease existing before the policy is effective (pre-existing disease), etc..
  • Claims procedures, including how well the types of documents must be completed. If your insurance company provides superior partner (provider), you have to know which hospital in your town who are the partners. The benefits of treatment in hospital partner is you do not need to spend money on insurance and pay the cost of care in advance.

2. Learn carefully hospital bills; At the time of leaving the hospital, the hospital will ask you to sign the details of maintenance costs will be billed to the insurance company or to you.

  • Make sure that the data is comprehensive care, including diagnosis, type of action, the cost for each item, the date of treatment, doctor’s name and data policy relevant. Little mistake in the writing of the name, could result in delayed payment of your claim.
  • Pay attention to word choice in the diagnosis. Handling the same but with a different diagnosis can get approval different claim. For example, if the diagnosis suggests that the disorder is congenital (inborn) although the trigger is a new disease, your claim may not be paid. Similarly with dental rehabilitation operations or parts of the face that are considered cosmetic. When you see there is a “gray area” in your policy, talk to the hospital and the insurance for interpretation does not harm you.

3. Ask a claim file as soon as possible; For insurance reimbursement without going through the provider, the claim must be filed after the completion of treatment. Insurance companies generally have a claim period expired. If it passes that date, your claim may not be paid. In addition, the submission also allows insurance faster to communicate with the hospital because the information is still fresh. Even more importantly, the sooner filed, the sooner you will get your money back.

4. Duplicate files your claim (proposed); you never know how good the quality of the administration of your insurance company. If for some reason you lose your files, you’ll be grateful because it has been a copy.

5. Do not immediately accept the claim denial; If you receive a rejection letter, learn why, compared with provisions of the certificate / policy. As far as the refusal is not because of something that was clearly stated in the policy, you are entitled to file a complaint. Tell your appeal orally or in writing to the insurer. In many cases, insurance companies are willing to budge or give partial compensation. In fact, almost every company there’s always insurance claims payments that are ex-gratia, the payment of claims that are not guaranteed in the policy. Ex-gratia payments are usually based on customer service and business considerations (sustainability policy).

6. Hire a lawyer; when the number of claims rejected is very large, there may be a benefit to you to hire a lawyer. The insurance company will respond to the very serious when you hire a lawyer. In addition to strengthening your bargaining position, the presence of lawyers also make the health insurance company worried because of its impact on the reputation of the company if the case spread into the community.

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