4 THINGS YOU MUST KNOW BEFORE MAKING A HEALTH INSURANCE CLAIM
Making a health insurance claim can be bothersome. First, you must check for eligibility. Then, you need time to prepare all the necessary documents. Here are 4 tips to help facilitate the approval of your claim.
KNOW THE DEADLINE
The best time to lodge a claim is “as soon as possible”. After any medical treatment or consultation, insurance companies usually allow 1 to 3 months to file for compensation. Once you miss the deadline, the insurance company can deny reimbursement.1
In some cases, your insurance company and doctor may accept pre-authorisation This means your doctor will send the bill directly to your insurance company BEFORE the medical service.1
Pre-authorisation can save your time and effort spent filing a claim. It also saves your worry about forgetting to make a claim during recovery. It may also put you at ease knowing beforehand that your insurance company will cover the expenses with pre-authorisation.2
Be sure to apply for the pre-authorisation service within the allowed period and beware that not all medical services or goods can qualify for pre-authorisation. In general, insurance companies allow pre-authorisation mainly on “medical necessities”. Please check your policy to be sure.2,3
HAVE ALL DOCUMENTS READY1
For minor medical compensation, such as generic drugs, you only need to submit a claim form, receipts and referral letters.
For larger amounts of reimbursement, such as hospital stays or surgeries, your insurance company may ask for the following documents:
Claim form. It should have your doctor’s signature and the hospital’s stamp. If you need to file for multiple claims, please remember to get all the claim forms signed and stamped.
Original hospital receipts, diagnostic reports, discharge summary, and sick-leave certificate. Some insurance companies may accept certified true copies. If you need to file for multiple claims, do ask the insurance company to send back the original documents and certified true copies.
CHECK ON THE DEFINITION OF “MEDICAL NECESSITY” IN YOUR POLICY1
Insurance companies will often only reimburse expensive hospital services they see as "medical necessaries". Your insurance company will judge based on criteria like, but not limited to the following:
- Was your condition urgent?
- Was outpatient treatment not feasible? "Outpatient" means you merely visit the doctor for consultation and treatment. "In-patient" means you spend a night or more in the hospital.
- Did you only get diagnostic scanning? Your insurance company may consider your hospital stay less necessary if you were not given medication.
SEE “REASONABLE AND CUSTOMARY CHARGE”1
Insurance companies often have a "reasonable and customary charge" for each medical service. A "reasonable and customary charge" is the normal rate for a medical service provided in your area.
You will not get full compensation if your claim exceeds the "reasonable and customary charge". Instead, you will need to pay out-of-pocket.
Remember to check the reasonable charge of the particular medical service. You should get quotations from multiple hospitals and doctors to avoid exceeding the reasonable charge. You can also consider applying for pre-authorisation to be sure that insurance will cover the cost.