How to claim health insurance
hpk
There is a wide selection
of insurance institutions to banks that offer their customers health insurance
facilities. Health insurance is usually
covered by hospital costs, which include maintenance costs (outpatient or hospitalization),
surgical expenses, surgery and so on. Many people have complained about the
difficulty of the claims validation from the insurance especially if the amount
of funds issued is large enough. To avoid this, you should understand the
medical insurance claim procedure for two types of treatment, inpatient and
outpatient.
• Inpatient
1. Qualify to make a
claim one of the main requirements to make a claim is the active period of the
premium you can not make a claim if the premiums in an inactive state. You
should also make sure that you have paid off all premium installments. In
addition, please ensure that the policy is not in the grace period or there are
certain exceptions such as types of illnesses or excluded treatment methods,
especially if your policy has been a lapse.
2. Contact insurance This
must be done before your hospitalization or later, if in case of emergency,
2x24 hours after hospitalization. You may contact the insurance agent or the
insurance party's medical service.
3. Include supporting documents at the time of
contacting the insurance, you must include your identity name, date of birth,
telephone number, policy number, hospital name or doctor you wish to go with a
referral letter from your doctor, symptoms, and Medical conditions that occur
as a reason for you to be hospitalized
4. Hospital selection
usually after the insurer receives your data, they will provide a hospital
reference to be an associate, although they can choose the desired hospital,
provided that it is still in the list of partner hospitals. Since the list of
partner hospitals is changing frequently, it's good to check the latest list by
contacting the insurance. The advantage of doing maintenance the hospital
provides no need to pay the maintenance fee into advance another word, you do
not have to spend a deposit.
5. Completion at the
hospital, you only need to show the identity of the policy (insurance card) and
then submit the administrative affairs to the hospital. All maintenance costs
will be borne by the insurer as long as the fee is still within the maximum
limit stated in the policy This means it is important to know the maximum limit
of health insurance benefits incurred. The difference of the fee shall be borne
by the insured person and must be settled before you leave the hospital.
• Outpatient The
following ways also apply to inpatient facilities in non-provider hospitals,
where the insured party must issue their own fees, and the insurer will make
the payment back after leaving the hospital.
1. Fill out the form by
including complete and correct information.
2. Completing document
claim requirements such as:
A. Proof of payment of
treatment fees and genuine receipts
B. Full report from the
original doctor
C. Treatment cost details
of the original physician
D. Cost of medicines and services provided
3. Make a claim as soon
as there is an expiry time for each insurance company to accept your claim. It
also helps cooperation between the hospital and the insurer to exchange
information.
When including a bill from a hospital, you
must ensure that the data is correct, ranging from the writing of the name, the
date of treatment, the doctor's name, and the relevant policy data This is to
prevent delays in the claims payment process. Diagnosis and action are also
important to note as it may inhibit claims approval.
The transactional word in
the diagnosis should be noted so that the insured party does not misunderstand.
Do not give up quickly, of course, there is the same possibility that our claim
is rejected or accepted, and if the claim is rejected, we recommend that you
re-learn the document or the reason for the rejection You as the insured person
reserves the right to appeal orally or in writing. It may be that this protest
can make the insurer get in and reimburse some of your treatment costs.
Although slightly, this would be better than nothing.
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