The general claim process is divided into 6 steps:
Preparing claims materials is a very important step. What should I prepare for
? Where to get it? Is the materials qualified? If the claims materials are incomplete, it is likely to affect the statute of limitations of the claims.
so, we have made a series of how to prepare claims materials for different insurance claims. Today is the first article about medical insurance . The content of
is very important. It is recommended that you collect first, and it will definitely be used at critical moments.
What materials are needed for medical insurance claims?
Generally speaking, it is the following 7 parts:
- Claim application
- Copy of the guaranteed copy (both sides of the ID card)
- Copy of the bank card that accepts compensation (do not use a credit card)
- All medical expense invoices;
- First medical treatment outpatient and emergency medical records/hospitalization full set of medical records
- Examination/test report form
respectively explain to you:
1. Claim application
If an insurance accident occurs, after the claim is filed, the insurance company will give everyone the application form and fill it out as required.
If the amount is small, most insurance companies support "small compensation". They do not need to fill out the application form, they only need to take photos of various materials and upload them to the official APP or official account to complete the claim application.
2. Medical invoice
must be the original "Invoice Coupon/Receipt Coupon" issued by the medical institution.
Although the medical fee invoices in various provinces across the country are slightly different, the invoice must be stamped with a unified Ministry of Finance supervision seal and a special hospital charging seal.
Correct demonstration:
Please note that the payment receipt/charging voucher printed on the independent payment machine cannot be used as reimbursement credentials. You need to go to the charging window to exchange for a formal invoice before reimbursement!
In addition, the patient retention links, stub links, medical insurance links, accounting links, etc. of the invoices look similar to those of the invoices, but they are not reimbursement vouchers.
error demonstration:
3. Inspection/test report
Common examination reports include:
- imaging examination report , such as X-ray examination, CT, MRI, contrast examination, molybdenum target examination;
- ultrasound examination report , such as B-ultrasound, color ultrasound;
- electrocardiogram report , such as routine electrocardiogram and 24-hour dynamic electrocardiogram , etc.
Common test reports include:
blood routine , urine routine, stool routine, serological test, and some secretion culture.
The left is the examination report form, and the right is the examination report
4. Medical record
outpatient and inpatient medical records are slightly different:
1) Outpatient medical record
Generally, hospitals have electronic medical records. After the patient is in the treatment, the doctor will print out the electronic medical records and sign/stamp to the patient.
There are also hospitals who still use paper door/emergency medical records, which is what we usually call "medical record book";
on the left is an electronic medical record, and on the right is a medical record book
No matter what kind of medical record it is, insurance companies recognize it.
Usually, after the treatment is over, the doctor will take the initiative to issue a medical record to the patient. If the doctor does not issue it, remember to ask the doctor directly.
2) Hospitalization medical record
If you are hospitalized, a complete set of hospitalization medical records are required, including:
medical record homepage, admission record, discharge record (discharge certificate/discharge summary), examination/test report form, medical order form, temperature form, surgical record, etc.
These materials often require a period of time to discharge the hospital, take the patient's own ID card and go to the hospital's "Medical Records Room/Medical Records Department" to copy it and stamp it with the hospital's official seal.
Also remind everyone not to let doctors write randomly on their medical records in order to prescribe some medicine.
medical records are recorded, so it will be difficult to buy insurance again.
5. Medical expense details
Medical expense details are the detailed list of corresponding invoices, indicating the specific name, unit price, quantity and corresponding amount of the charging items.
The invoice below only lists the charging items as "Western medicine". If it does not reflect the specificity, it cannot be used as a basis for claims.
The hospital must issue another medical expenses details in order to be reimbursed normally. (Please note that the hospital seal is stamped)
Some invoices have been listed in the details, so there is no need to issue an additional details.
6. Accidental medical reimbursement
part of the accidental medical claim in the accidental insurance. will require additional evidence of accidental injury on the basis of medical insurance.
For example: injury photos, traffic accident identification certificate, work-related accident certificate, accident certificate issued by the police;
If it is a travel accident insurance, you must also provide travel certificates, such as travel photos, travel contracts, boarding passes, etc.;
These are all to prove the authenticity of the accident. Remember to keep it well to avoid making trouble when resolving the claims.
Small summary
claims materials are indeed a lot. This is not because the insurance company wants to deliberately make things difficult for everyone, but to reflect the authenticity and reasons of the facts.
Many materials look troublesome, but they can be obtained normally during treatment/processing. As long as you pay attention and do a good job of collecting and organizing it, it is not as difficult as you imagine.
Different information may differ depending on the company, region and product. After the accident occurs, try to report the case to the insurance company as soon as possible to understand the specific requirements.
Finally, if a special situation occurs in , don’t be anxious, keep calm and actively communicate with insurance companies or intermediaries. Insurance companies are not just a decent person, and there is room for negotiation for many things.
If there is indeed an unreasonable situation and the negotiation cannot be reached, we will also support everyone to protect their rights reasonably.
