Ways to Claim Health Insurance

Understand 5 Ways to Claim Health Insurance


Some people may choose health insurance to help us in the treatment process when sick and the insurance will cover every hospital treatment cost.

The government is now intensively holding an insurance program that can help the community, especially the poor, to be able to take treatment.

Health insurance is indeed considered to have several benefits, namely, it helps us in doing treatment, especially those that require large costs such as surgery. Not a few of them find it difficult to find medical funds with high enough costs.

Therefore, people are now turning to take part in a health insurance program from the government that can help with any treatment. Although currently many have insurance, some of them even do not know or understand the procedure for claiming insurance.

Even though the procedure has been explained by the agent and is written in the policy book. For that, we need to re-understand the ways and procedures to claim our insurance.

Understand 5 Ways to Claim Health Insurance


1. Make sure to Always Pay the Premium


When we decide to have health insurance, it’s good to consider the premiums that must be paid each month. Make sure that our monthly income can be sufficient to pay for health insurance deposits. By calculating beforehand so that we can pay the monthly premium and make it a mandatory expense every month.

If we don’t pay premiums regularly every month then one day it will become a fairly high billing burden and will burden us. That way, make sure that none of our policies are hollow or forget to pay the monthly premium.



2. Make sure the active period of insurance is more than 30 days



Many insurance companies set the active period of the insurance after 30 days. For this reason, if it is less than 30 days, then if we want to go to the hospital for treatment, it will most likely not be accepted or rejected, except in urgent conditions such as accidents.

So beforehand we have to make sure that the active period or the age of the policy has been more than 30 days since applying for the health insurance.


3. Make sure to read the Exception Clause


After we officially have health insurance and get a policy, then several things must be considered. For example, reading the policy in the exception clause.

The following are some examples of the contents of the exclusion clause listed on the policy. For critical diseases such as coronary heart disease and 34 other critical illnesses, it can only be claimed after at least 6 months.

That way, if we have previously had heart disease, we shouldn’t be in a hurry to claim it, try waiting 6 months to 1 year before we can claim. For diseases that have existed before, whether we know it or not, the insurance company will not cover it.

For example, for congenital diseases, make sure to check the insurance ceiling that has been provided for us. This ceiling contains the maximum share of medical costs that will be covered by insurance as long as we are treated. If you use more than the stated cost of care, you have to pay back for the shortage.



4. What If We Suddenly Get Sick?

If on the insurance card there is an international SOS number, then call to ask the nearest hospital that we can refer. After getting a hospital referral, usually, the hospital will ask whether the treatment room will fit the ceiling or higher.

If we really can add to the shortage, it doesn’t matter if we choose higher than our ceiling. Generally, hospital insurance uses a card and, with that card, so we do inpatient treatment for free or do not spend a penny because everything has been covered by insurance.


5. Pay Later (Reimbursement)


In health insurance, there is a reimbursement method or pay later. So when doing treatment, we have to pay for the treatment ourselves first, but these costs will be reimbursed at the end by the insurance.


The following is the procedure for reimbursement. In the reimbursement method, there are 2 types of forms of claims, namely the customer claim form against the insurance company, and the second form is a certificate from the treating doctor.


When you go to the hospital, make sure to bring both forms and give them to the nurse, then they will fill it out with a stamp. hospital. After completion, we will get a bill receipt for the treatment we did from the hospital, make sure to photocopy the receipt and, ask the hospital to legalize it, because the original receipt will be requested by the insurance company.


After returning from the hospital we will have 3 documents, two claim forms and, one receipt. After that then we can complete it with a photocopy of the ID card and a photocopy of the account book.


These documents are then given to the insurance claims department concerned. We can monitor the process by telephone and after a maximum of 14 days, we will receive a refund of the amount stated on the receipt from the insurance.



Pay attention to the claimed method



Metode For some people, the steps above are still considered a little confusing. But make sure to go back to understand it so that we get the benefits of the health insurance that we have. In essence, whatever type of insurance you use, try to make sure by asking in advance about the insurance claim mechanism.

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