Tips to submit the Health Insurance Claim

Understand the methods of the health insurance claim submission benefit’s is to prevent the bustle and increase your opportunity of getting the claim replacement.Matter that must be done by you when submit the health insurance claim:

1. Read the Certificate / the Policy of your health insurance.Before undergoing the treatment in the hospital, study all the provisions concerning the benefit of the policy.When you were participants in the collection health insurance, you are usually given by one list of the benefit of the policy.And you could ask the human resources department to know the limitations benefit according to the policy of your company.For you as the holder of the individual policy, you could ask directly to the agency and your claim service part of the health insurance company's.

Matters that must be know from your certificate policy.

The benefit of the health insurance, the maximum limit for each one of treatment kind and remaining limit that were owned by you. The exceptions, which is the illness kind or the treatment method that was exempted, for example: the congenital disorder illness, the cosmetic operation, the available illness before the effective policy (preexisting disease), etc.

The claim procedure included the method and the document kind that must be equipped. When your health insurance company provided the counterpart's facilities (provider), you must know any hospital in your city that became the counterpart. The benefit carry out the treatment in the counterpart’s hospital is you might not spend money for the guarantee and paid the treatment cost in front.

2. Study carefully the hospital bill before submit claim.When leaving hospital, the hospital will ask you to sign details of the treatment cost that will bill to the insurance company or to you.

Confirm that its treatment data was complete, covered the diagnosis, the action kind, the cost for each one item, the date of the treatment, the name of the doctor and the relevant policy data. A little mistaken for example wrong or misspell name can make your claim payment postponed.

Pay close attention to the context said in the diagnosis.The same handling but with the different diagnosis could get the different claim agreement. For example, when the diagnosis showed that his deviation was congenital (the congenital condition) although his trigger was the new illness, your claim could not be paid. Same with the teeth rehabilitation operation or the face part that it was considered cosmetics. When you see the “grey territory” in your policy, discuss with the hospital and the health insurance company so that the interpretation is not cause a loss for you.

3. Submit the bundle of the claim as immediately as possible.For the insurance that is shaped like a replacement (reimbursement) without through provider, the claim must be immediately submitted after being finished the treatment. The insurance company generally has the overdue period of the claim submission. If through this date, your claim could not be paid. Moreover, the faster submission is bringing ease for the health insurance company to communicate with the hospital because their information was still fresh. The more important is submitted faster mean you will get your money back faster too.

4. Copy the bundles of the claim that was submit.
You had never known as good the quality of your insurance company’s administration. Because of something happened your bundle was lost, you will be grateful to have its copy.

5. Don't immediately accept the claim refusal after submission.If you receive the refusal letter after submission, study its reason, compare with the provisions in the certificate / your policy. When its refusal not because something that is very clears that was calibrated in the policy, you had the right to raise the objection. Send your defense orally or written to the health insurance company. In many cases, the insurance company yielded or gave some compensation. Moreover, almost in each insurance company always does claim payment that is free (ex-gratia), which is claim payment that is not guaranteed in the policy. That ex-gratia payment usually was provided by the consideration of customer service and the business (the continuity of the policy).

6. Use the lawyer service.When the amount of the claims that was refused is very big, possibly it is fortunate for you to hire the lawyer. The health insurance company will respond to very seriously when you use the lawyer. Besides reinforcing your bargaining position, the presence of the lawyer also made worry the insurance company because of its impact on the reputation of the company when that case is spread up to the community. The settlement opportunities are bigger in cases that involved the lawyer.