When high-end medical insurance customers seek medical treatment, they are sometimes unable to achieve direct payment because they forget to bring their direct payment card or go to a hospital where direct payment is not available. At this time, you need to make advance payment a

High-end medical insurance customers sometimes fail to realize direct payment when seeking medical treatment because they forget to bring their direct payment card or go to a hospital where direct payment is not available. At this time, you need to make advance payment and then make subsequent claims to complete the insurance claim. There are three issues that require special attention when making high-end medical claims.

1. Claim settlement materials are not fully prepared, causing claim settlement to be delayed or failed.

When making subsequent claims, the most common problem is that there is no corresponding claim materials, resulting in a failed claim. Under normal circumstances, when making subsequent claims, invoices, cases, and expense details are all indispensable. Lack of any one of them will result in claim failure. Moreover, when performing some special treatments, the required materials will also increase. At this time, specific issues need to be analyzed in detail.

2. Whether the medical expenses are within the scope of insurance claims.

Many customers are making subsequent claims and reimbursements. Often, compensation is denied because the treatment you receive is not covered by the insurance company’s terms and conditions. For example, the traditional Chinese medicine benefits of some products have limits or times. If customers are not careful, they will not be able to make claims after checking the limits or times. Another example is that the full compensation cannot be paid because there is no pre-authorization. There are many of these issues, and they also require detailed analysis of specific issues.

3. There are restrictions on online claims settlement.

In recent years, some insurance companies have launched online online claims settlement services in order to facilitate customers to make subsequent claims settlements. Customers only need to download the app or log in to the insurance company to upload materials to complete the subsequent claims settlement process. However, many insurance companies have set limits for online claims, generally for outpatient treatment below 3,000 yuan. Claims cannot be settled online if the amount exceeds 3,000 yuan or has been hospitalized.

In response to the above problems, Huiyin Lintai High-end Medical Insurance has professional and detailed solutions.

will be introduced to you in the next issue.

What issues need to be paid attention to when making high-end medical post-event claims?

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