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Medical Insurance Claim: How does reimbursement work?

Medical insurance claim
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Being able to make a medical insurance claim when we are sick means we don’t have to worry about the financial cost of treatment or services.

Greater competition and UAE rules mean that the claims process for health insurance isn’t as complicated as you might think.

Our six step guide takes you through everything you need to do to get reimbursed within 5-7 working days, direct to your bank account.

When something goes wrong with our health, or the health of our loved ones, it can be terrifying. Without medical knowledge of our own, knowing what to do or how to fix it isn’t an option. We have to rely on others to help. That is why health insurance is so important. When our health is threatened, we can get vital help and make a medical insurance claim.

Isn’t the medical claims process confusing?

Health insurance allows us to get medical assistance with ailments, illnesses, and accidents. It gives us peace of mind that things can be fixed without creating financial issues. You can go and see the doctor, get a prescription, and visit a hospital, all covered by your health insurance. That means you can concentrate on getting better without worrying about money.

However, when it comes to the medical claims process of insurance, many of us think it might be confusing. We recall the extensive table of benefits in the policy and worry a reimbursement claim might be complicated. Luckily, this isn’t the case. The evolution of the insurance industry has created greater customer care than ever before. The top insurers focus on making their policies more accessible and flexible. They prioritize customer care and quality of service so they can be competitive to a demanding customer base. This means that you get a more reliable level of care, a larger area of coverage, and more assistance when needed.

To make sure you know exactly how medical claims processing works, we have put together a step-by-step guide. That way, you know exactly what to do and what to expect when you make a health insurance claim.

The step-by-step process to a reimbursement claim

Step One: Check your policy.

Before you head to the doctor or the clinic, make sure to check that they, and the service you need, are covered in your policy network. You will only be able to make a medical insurance claim for treatments, test, or services, included in your policy. Whether you need medical help locally or while abroad, try to check if it is covered before you go. You can do this either by the phone (there will be a number on your medical card) or online via the insurers’ website or app. If you don’t have a location in mind, they can advise you on the closest, most appropriate place. It shouldn’t take longer than a couple of minutes.

Step Two: Go to the doctor.

Make sure to get the help you need, as quickly as possible. Your health is the most important, of course!

Step Three: Document collection.

When you have received your medical care, you will need to gather all of the relevant documentation that your insurance company will need.

For every reimbursement claim, the insurer will require details of what was done or performed. The documents needed will depend on the appointment, in-patient, or out-patient.

In-patient appointments are those that need an overnight stay in a hospital or treatment center. Out-patient services cover everything that doesn’t require rest, such as doctor visits, tests, short treatments, etc.

For out-patient treatments, you will likely need copies of documents such as medical reports, prescriptions, lab tests details and results (ie, for an MRI) and the receipt for services.

For in-patient services, you will need copies of those documents as well as an exit report and discharge summary from the hospital.

Step Four: Submit your documents.

Once you have paid the fee and received your receipt, you need to submit this, with your documents, to your insurer. The more documentation you can provide, the smoother the medical claim process you will have.

Submitting your documents can be done two ways, in person or online. You can submit your paperwork in-person to your insurance broker, although this way might take a little longer. You can also submit your paperwork online through the insurer’s website or app. Uploading copies of your documents online will be the fastest method for reimbursement. Whether you have your policy or a group one from your employer, you deal directly with the insurer for privacy.

Step Five: Track your health insurance claim.

If you have made your reimbursement claim online, you will be able to track the process at every step. Your insurance company will also notify you if more documents are required to complete your claim. This is the part where they need to authenticate the documents so they can release your reimbursement payment.

They will also check to make sure the policy covered the treatment or service. If you did the process online, the average time it takes is 5-7 working days, a little longer if not online.

Step Six: Reimbursement.

Your health insurance company will arrange for you to be reimbursed for your medical insurance claim. You can request your preference for the method as well. They can either transfer the funds directly into your bank account, or they can issue a cheque for you to collect.

All in all, the process has been streamlined to be as simple as possible; it isn’t there to trip you up. The medical, and administrative, staff at the healthcare facilities are well versed in health insurance processes. They know that you will need documentation for reimbursement claims and they will help you gather what you need. The insurance companies are very familiar with the medical documentation for each treatment, so they are quick in their assessments. That way, you can focus on getting better or helping a loved one, not worrying about your bank account.

Health insurance claim reimbursement process proved to be quite smooth when all the paperwork is available and organized. However, things might get more complex when managing a group medical insurance. Aqeed People automates and simplifies your employee’s health insurance journey. It’s fully autonomous software gets you the best quotes from the top medical insurance companies in the UAE and manages your group health insurance policies renewals.


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