How are claims handled under international health insurance
Claims under global health insurance plans from Pacific Prime are normally handled in a number of different ways, with the claims method often changing depending on the type of treatment being received and the length of the notice of treatment which you have given to the international health insurance company.
The two types of claims you will most likely make under an international health insurance policy are Inpatient and Outpatient.
Inpatient medical treatment refers to any healthcare you may receive where an overnight stay in a hospital is needed. Basically, if you are “checking in” to a hospital and will be sleeping at the facility for at least one night then the treatment will usually be termed “inpatient.”
In the event that you are going to receive scheduled inpatient treatment – that is, inpatient care outside of an emergency situation – then you will normally have to complete a form known as a Treatment Guarantee.
Once you have completed the Treatment Guarantee form simply send it back to your insurer. From there the insurance company will contact the hospital directly to arrange payment. The benefits of completing a Treatment Guarantee form prior to receiving scheduled inpatient treatment at a hospital are twofold. 1) You will have a clear indication of whether the treatment you are about to receive is covered under your policy, and 2) you will enable the insurer to settle the bill of the treatment directly with the hospital.
However, not all inpatient medical treatment will be scheduled ahead of time. In the event of an emergency it will be necessary that you, or someone on your behalf, contact your insurer to inform them of the situation as soon as possible upon admittance to hospital. When you contact your insurance company during emergency treatment they will normally liaise directly with the medical facility to ensure that the costs of treatment are settled.
Outpatient medical treatment normally refers to any medical treatment where an overnight stay at a medical facility is not needed. General Practitioner and Doctor’s checkups are good examples of outpatient medical treatment.
In most instances of outpatient medical treatment it is normal that the policyholder will have to pay for the costs associated with the care as soon as they have seen a doctor. Once they have paid for the treatment the policyholder will then need to submit a claim to the insurance company to receive reimbursement for their medical expenses.
In some cases you may be receiving your outpatient medical treatment at a clinic or facility which has a direct settlement agreement with your insurance provider. In the case that your plan allows for direct settlement of outpatient medical expenses, simply present your policy details, such as your insurance membership card, to reception and receive your healthcare – your insurance company will arrange payment directly to the medical provider.
It is important to note that even though there may be direct settlement options under both inpatient and outpatient treatments that you, as the policyholder, will be responsible for covering any deductibles, or excesses, which may exist on your international medical insurance plan.
When submitting the initial application for an international medical insurance policy through Pacific Prime you will be given the choice of deciding whether or not to include a deductible on your plan. A deductible is a portion of the total healthcare costs which you are responsible for paying.
For example, you may have elected to include a $100 per-condition on your plan. In the event that you see a doctor, and the consultation costs $300, the insurance company will pay $200 of the total bill while you are responsible for the $100 deductible.
Deductibles are not mandatory on international health insurance plans from Pacific Prime, but choosing to include one on your coverage can mean that you will be able to significantly lower the overall policy premium – meaning that you will, ultimately, pay less for coverage.
For more information about international health insurance deductibles, please click the link.
While the dedicated, In-House claims team at Pacific Prime can help you to receive a speedy reimbursement of medical expenses that you have had to pay for (under an outpatient insurance claim, for instance) it is important to note that there are two major potential stumbling blocks in relation to claims settlement under international health insurance plans.
If you have to submit a claim to the insurance company after having had to pay for the costs of your medical treatment out-of-pocket then it is vitally important that you follow the claims process exactly. This includes providing the correct documents as asked for by the insurance company, such as Receipts for the treatment costs, doctor’s notes, and a fully completed claims form.
Failure to strictly adhere to the claims process as specified by the insurance company underwriting your plan will often mean a delay in reimbursement.
Pre-existing Medical Conditions
The number one cause for a delay in claims is in relation to pre-existing medical conditions. These are medical conditions which were present, or which you knew about, prior to purchasing an international health insurance plan.
While Pacific Prime can provide options for the coverage of pre-existing medical conditions, it is typical that a majority of insurance companies will simply exclude pre-existing from the cover – meaning that these conditions are not eligible to receive claims reimbursement under the policy.
If claims are important to you then you’ll be pleased to hear that our dedicated In-house claims team will work with you to ensure that all aspects of your health insurance claim are handled in a smooth and efficient manner. We will double, triple and quadruple check your claims paperwork and ensure that all the relevant documentation has been provided.
We will contact the insurance companies, and navigate through their often highly confusing claims procedures on your behalf – freeing up your time to concentrate on your recovery. In fact, due to our extensive long-term relationships with many of the world’s best insurance companies, we can actually do things like submit copies of medical receipts, rather than the originals, so you can save the original documentation in your files free of fear that it may get lost.
For more information on the claims process under an international health insurance policy, or to learn more about the coverage that Pacific Prime can offer to expatriate around the world, please Contact Us to speak to an expert health insurance broker. Alternatively, simply complete the short form at the top of this page to receive a free quotation comparison today.
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