How are International Health Insurance Claims Handled

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

Answer: 

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.