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How are International Health Insurance Claims Handled

How are International Health Insurance Claims Handled

Does your plan will pay directly or I have to file after I pay from my pocket and get reimbursed?

A Pacific Prime health insurance plan will require you as the policyholder, to submit a claim to your insurance provider for reimbursement against the cost of any treatment that is included as part of your plan.

This claim submission is known as a claims application and there are a variety of ways that an insurance provider can choose to process this. It is vital you understand the claims procedure of your particular insurer and what paperwork (application form, hospital bills, receipts etc) is necessary to fully process your claim. The more organised and thorough you are with your paperwork; the more efficiently the claims application can be processed. If you are unsure what documentations you must provide, be sure to clarify this with your provider upon deciding on your particular health insurance plan.

Pacific Prime health insurers typically process their applications in one of the following ways:

In-patient Health Insurance Claim Treatment Guarantee

In-patient coverage often includes treatment that requires an overnight stay in a hospital or clinic, room rates, anaesthetics and other surgical related costs.
In some instances, you may need to receive regular in-patient medical treatment at a hospital. If this is the case, you will need to inform your insurance provider before the course of treatment has begun. Your provider may require you to complete a Treatment Guarantee Form and this will allow them to contact your hospital or clinic on behalf of yourself and directly settle treatment costs this way.

In-patient Emergency Treatment Claim

There is always the chance of course, that you experience a sudden injury or illness and are unable to notify your insurance provider before you are brought to a hospital for immediate treatment. If this happens to you, most insurance providers will settle medical expenses directly with the hospital and require you to contact them as soon as possible to discuss the settlement.
Some insurers may suggest that you draft an emergency response plan as this will help you with your claim if such an incident were to take place as well as ensuring those close to you to know to provide both the hospital and insurer with the necessary information.

Out-patient Direct Settlement

Out patient coverage refers to treatment that does not require hospitalisation such as general practitioner fees, prescribed medicines and lab tests.
The direct settlement option is particularly beneficial to those making claims for this kind of coverage. What happens here is that the insurance provider has agreements put in place with numerous medical facilities, hospitals and clinics and this allows them to directly settle the cost of treatment you have received at one of these facilities. To ensure this process takes place, you simply need to provide the medical facility with your health insurance information and your insurance provider will then be contacted to directly settle your treatment costs.

General Out-patient Claims

With this method of claims processing, you are personally required to cover all treatment costs out of pocket at the time of treatment but can then claim your refund at a later date which will then be reimbursed to you via a number of repayment methods.

The claims application process can certainly be a confusing one but it is paramount to you receiving the coverage you require so if you desire additional information and advice, contact a member of our expert team of brokers and we will be happy to help you with any query you may have.

One major factor that may affect your claims application is whether or not you are considered to have a pre-existing medical condition by your insurer.

A pre-existing medical condition is usually considered to be any illness or injury that you may have experienced symptoms of or previously received treatment for before the start date of your policy. Depending on your insurer, coverage for such a condition may not be possible so you need to clarify this with your insurer before making claims against any treatments.

For more information regarding claims application, or any other health insurance query you may have, please contact the team here at Pacific Prime and a dedicated broker will be happy to provide you with any information you require. Alternatively, you can simply complete the short request form at the top of this page and we will provide you with a free quotation shortly.

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