Understand tips beneficial health insurance claims in order to prevent unnecessary hassles and increase your chances of getting a replacement. Here are the things you need to do when claim health insurance :
1. Read your Certificate / Insurance Policy. Before undergoing treatment in hospital, learn all the provisions of the policy benefits. If you are a participant of collective health insurance, you are usually given a list of policy benefits. You also can ask the personnel office (HRD) to find out the limits policyholder benefits according to your company. For your individual policy holder, you can ask the agency and the services your insurance company's claims.
Things that need to be known from your insurance certificate and policy:
2. Learn about hospital bills carefully. When you leaving the hospital, the hospital will ask you to sign the details of treatment costs will be charged to the insurance company or to you.
3. Submit a claim file as soon as possible. For insurance reimbursement without going through provider, the claim must be filed after completion of treatment. Insurance companies generally have a period of filing claims expired. If that date passes, your claim can not be paid. In addition, faster you filing your claim also faster faster for insurance companys to communicate with the hospital because the information is still fresh. More importantly, sooner you submit your claim, faster you'll get your money back!
4. Make a copy files of claims. 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 glad you have a copy.
5. Do not immediately accept the rejection of the claim. If you receive a rejection letter, learn the reason, compared with provisions of the certificate / your policy. As far as the refusal was not because of something that was clearly stated in the policy, you have right to raise objections. Convey your "defense" orally or in writing to the insurer. In many cases, insurance companies are willing to budge or give partial compensation. In fact, almost every insurance company there's always the payment of claims 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. When the number of claim were rejected very large, there may be in it for you to hire a lawyer. The insurance company will respond very seriously when you use a lawyer. In addition to strengthening your bargaining position, the presence of lawyers also worried the insurance company because of its impact on the company's reputation, if his case is spread into the community. Chances of winning health insurance claims is much greater in cases involving a lawyer.
1. Read your Certificate / Insurance Policy. Before undergoing treatment in hospital, learn all the provisions of the policy benefits. If you are a participant of collective health insurance, you are usually given a list of policy benefits. You also can ask the personnel office (HRD) to find out the limits policyholder benefits according to your company. For your individual policy holder, you can ask the agency and the services your insurance company's claims.
Things that need to be known from your insurance certificate and policy:
- Health insurance benefits are paid, the maximum care limit for each item and rest of the limit you have
- Exceptions, namely the type of disease or what treatment methods are excluded, eg congenital disorder, cosmetic surgery, the disease that existed before the policy effective (pre-existing disease), etc.
- Claims procedures, including what types of documents that must be completed. If your insurance company provides partner (provider), you need to know which hospital in your town who become partners. The advantage to treatment in hospital partners is that you do not need to spend money and pay guarantee in advance.
2. Learn about hospital bills carefully. When you leaving the hospital, the hospital will ask you to sign the details of treatment costs will be charged to the insurance company or to you.
- Ensure that complete treatment data, including diagnosis, type of action, the cost for each item, the date of treatment, doctor's name and the relevant policy data. Just a little mistake in the writing of the name-for example-can lead to delay payment of your claim.
- Pay attention to word choice in the diagnosis. Handling the same but with different diagnoses can get a different claim approval. For example, when the diagnosis suggests that the disorder is congenital (inborn) even though the trigger is a new disease, your claim can not be paid. Likewise with dental rehabilitation operations or parts of faces that are considered cosmetic. If you see any "gray areas" in your policy, talk with the hospitals and insurers text concerning that not harm you.
3. Submit a claim file as soon as possible. For insurance reimbursement without going through provider, the claim must be filed after completion of treatment. Insurance companies generally have a period of filing claims expired. If that date passes, your claim can not be paid. In addition, faster you filing your claim also faster faster for insurance companys to communicate with the hospital because the information is still fresh. More importantly, sooner you submit your claim, faster you'll get your money back!
4. Make a copy files of claims. 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 glad you have a copy.
5. Do not immediately accept the rejection of the claim. If you receive a rejection letter, learn the reason, compared with provisions of the certificate / your policy. As far as the refusal was not because of something that was clearly stated in the policy, you have right to raise objections. Convey your "defense" orally or in writing to the insurer. In many cases, insurance companies are willing to budge or give partial compensation. In fact, almost every insurance company there's always the payment of claims 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. When the number of claim were rejected very large, there may be in it for you to hire a lawyer. The insurance company will respond very seriously when you use a lawyer. In addition to strengthening your bargaining position, the presence of lawyers also worried the insurance company because of its impact on the company's reputation, if his case is spread into the community. Chances of winning health insurance claims is much greater in cases involving a lawyer.
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