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Health Claim Form Need

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medexplans claim form

  Health Claim Form Need.

I will try to abolish myth about how complicated process it is. I speak almost every day with many different people. Sometimes they tell me about big insurers who don`t need a claim form to get filled in. I always listen and see what I can do to make things easier for my clients. I decided to check myself what`s the reality behind it.
I picked up the phone and made a few calls to find out what`s the catch. Well, there is no catch at all. What I found is that big players on the market need a claim form submitted by their clients at some point. The claims are often detailed with many questions. One of the reasons behind it is to make sure that insurance is not used by the third person. They have correct bank account details where reimbursement is to get paid. Furthermore, they have to take into account any pre-existing or chronic condition. It might get excluded from coverage.

Let me give you two examples, which might give the impression of direct billing, even if it`s not the case:

  1. “Will the insurance pay when I go to the hospital?”
  2. “Will the insurance pay when I am in the hospital?”

If I was to answer straight away, I would say: “Yes, of course.“
The questions above are not the same. First says: “…I go to…” and another “…I am in…

You see, this is where you might get confused. In both cases the insurance will pay it, but whether we need to fill in a claim form or not depends on the situation. They both may not need claim form at all or may need one. See below examples.

The insurance will settle direct billing with hospitals when you are in the hospital. Actually, you are “admitted and must stay” You see, here is my point?

You can go to the hospital for a treatment or you can go to the hospital to spend a few days. The same is another question. You can be in the hospital to see a doctor or you can be in a hospital where you will stay overnight or a little bit longer.

• Direct Billing – no claim form is necessary – admitted to the hospital, must stay. This is in-patient treatment.
• Reimbursement – claim form is necessary – daytime treatment, visit a doctor. Not need to stay overnight. This is out-patient treatment. In this case, you pay first and later claim reimbursement.

Important Notice:

1. The insurance company has their own network of health care providers. It doesn`t mean they have direct billing with them.
I`d say, they prefer you go there. You might also get the limited choice as the only facilities you get allowed to go when you get sick. Remember, that you should have always free choice where you want to get treated.

2. You can find on The Internet about direct billing with hospitals, but don`t get misled. It usually means: only when you get admitted to the hospital. Otherwise, you need to fill in the claim form to get reimbursed. Make sure to always confirm with an insurance consultant.

At the end, I want to add that you DO NOT NEED to fill in a claim form each time you visit a doctor. This is because it`s related to the same health condition. Unless you get different illness several times a month, then you will need to fill in the form each time. I think is unlikely to happen after all.

Please share this article and write your comments below. I would like to know your thoughts and experience wherever you are. Thanks.

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