Claims

Medical Insurance Companies settle claims in three different ways and these are as follows:

1. For scheduled in-patient treatment the insurer commonly requires the insured to complete a ‘treatment guarantee form' prior to treatment. This allows the insurer to contact the hospital and confirm payment direct to the hospital. In the case of emergency in-patient treatment the majority of insurers will settle medical expenses directly with the hospital. In this instance it is advisable for the insured to contact the insurer as soon as possible to arrange settlement.
2. It is common practice in some countries for insurance companies to establish direct out-patient networks, whereby the insured can attend an out-patient clinic and have the bill settled directly with the insurer without the insured having to pay the initial fee.
3. The standard procedure for out-patient treatment requires the insured individual to initially pay the medical bill and then submit a claim form and original receipt to the insurance provider. The policy holder will then be reimbursed by the insurance company through the agreed method of payment.

Complaints regarding Claims

Occasionally problems can arise when claims are submitted. The most commonly occurring reason is incomplete paperwork. Completing the paperwork correctly is the direct responsibility of the individual and will ensure prompt settlement. Pre-existing Conditions can also cause problems, as they are generally excluded. The client should ensure that the pre-existing condition has been accepted and is included in the policy otherwise the claim will not be settled.

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