You are admitted into hospital for a surgery. When should you inform your insurance agent and how soon can you submit your claims? What if your claims are rejected? Is there anything you can do to appeal?
Most of us have a health insurance policy. However, not many of us are aware of how to make medical or health insurance claims when the need arises.
The procedure actually varies according to different insurance companies. However, there are a few standard procedures to be aware of:
WHAT SHOULD I DO?
Firstly, check your policy contract to determine if you are entitled for coverage for the event that you intend to file a claim. As a policy holder, it is your responsibility to check and to ensure that you are covered for that particular event to avoid complications.
Then, be sure to check that your policy is in force by checking your premium payment records. If all is well, your next step would be to fill in the necessary claim forms and documents accurately.
Once the necessary documentations are complete, submit your claims with the relevant attachments to your insurance company’s claim department. This can be done via mail or through your insurance agent.
Keep connected with your insurance agent or contact the customer service department of the respective insurance company to ensure that your claims are ready for processing.
If you do not have a medical card and would like to file for a reimbursement, there will be a processing period which should not take longer than stated if all of your documents are accurately filled and completed. This period of time is required for the insurance company to verify the validity of your submitted documents with the hospital and authorities.
If there is missing information or documents, the processing period may take longer. Generally, claim submissions that provide accurate information in the attached documents will not take more time than it should to be resolved.
If you own a medical card, be sure to present the card upon admission. If you are an owner of a medical card but is unable to present the card upon admission, inform the hospital that you own a medical card and provide them the name of the insurance company together with your full name and identity card number. The hospital staff would be able to assist you in obtaining the necessary details. However, this may require a few hours. An alternative would be to inform your insurance agent regarding your hospital admission and ask to make the necessary arrangements.
WHAT DOCUMENTS DO I NEED?
If a medical card is submitted upon admission, the patient is not required to fill in any forms. Instead, the hospital will inform the insurance company regarding the admission and will issue a Guarantee Letter to confirm. This provides you the speed and convenience needed during emergencies.
If you do not have a medical card, you will be required to settle the hospital bill first, then file for an insurance claim. The documents that must be submitted are:
- Hospital claim forms
- Doctor medical attendance report
- Official itemised bill and receipt from the hospital
WHAT IF I WAS ADMITTED IN AN EMERGENCY?
If you are admitted into the hospital due to an emergency, it is important that you or your family members inform the hospital to proceed with the necessary treatment first.
After that, do not forget to show the medical card to the hospital or call your insurance agent and company regarding your hospital admission.
Depending on each individual case, you may be required to put a deposit via your credit card as the hospital may require time to liaise with the insurance company to obtain a Guarantee Letter.
If a policy owner goes into coma, a family member is required to call the insurance agent or provide the hospital details of the patient such as the name of the insurance company, full name of the patient and identity card number. Through this, the hospital will be able to obtain information of the patient via the system.
If no medical card is provided, the patient will be required to make the necessary payment and file for a claim to the insurance company.
WHAT IF MY CLAIMS ARE REJECTED?
According to Life Insurance Association of Malaysia (LIAM), there are a few possibilities for the insurance company to reject your claims:
- Your policy is no longer in force, lapsed or expired due to cash value exhaustion.
- Non-disclosure material, claims for events under the excluded risk list that is not within the scope of coverage.
- The disability or illness does not meet the policy’s definition of the terms and conditions stated.
If you have any queries on insurance claims, be sure to contact your insurance agent or the customer service department of your insurance company to clarify.
If you are having difficulties with your insurance claims, here is what you can do:
- Try and resolve the matter with your insurance company by referring your case to the Complaints unit.
- If you are unable to resolve the matter at that level, file a complaint to the Financial Mediation Bureau (FMB) or Bank Negara Malaysia (BNM) who will look into your complaint at no charge.
DID YOU KNOW?
- Some insurance policies cover pre-surgery and post-surgery costs. Don’t lose out on this benefit if you are entitled for it.
- It is important to inform your family members where you keep your insurance policies, the insurance company’s name and your insurance agent’s contact details. This is vital especially in the event of an emergency.
- You are required to notify your insurance company and agent regarding your admission within 14 days from the date of the event.
- When submitting documents to the Claims Department, be sure to submit everything all at once and not in batches to avoid complicating the reimbursement process.
eTIQA – 1300-13-8888
Allianz – 03-2264 1188
AmAssurance – 1300-88-8800
AIA – 03-2056 1111
AXA AFFIN Life Insurance – 1300-88-1616
CIMB AVIVA – 1300-88-5055
Great Eastern – 03- 4259 8888
Hannover Life Re – 03 – 2687 3600
Hong Leong Assurance – 03-7650 1288
ING Insurance – 1800-88-0303
Malaysian Life Reinsurance – 03-2780 6611
Manulife Insurance – 03-2719 9228
MCIS ZURICH – 03- 7652 3388
Prudential – 03 – 2116 0228
Tokio Marine Life – 03 – 2059 6188
Uni.Asia Life – 03 – 2687 2020
Zurich Insurance – 1300-88-8622