Claims, claims, claims. Is there perhaps anything more frustrating to deal with when you’re sick? Anything more annoying than having to pay thousands out of pocket, only to receive a fraction of the amount a few months down the line? Claims aren’t ideal, but they aren’t a prerequisite of your insurance policy. You can easily get by never having to claim again if you understand your insurance plan and your insurer’s policy on claims. Take the time to get familiar with your policy so that you understand the financial implications beforehand.
Key Items to Check
Here are a few questions that you need to answer while getting familiar with your health insurance policy:
- Which hospitals and clinics does your plan cover in the UAE and abroad?
- What is the deductible or co-payment amount?
- For what treatments is pre-authorization required?
- Are there any coverage limits for specific treatments?
Get in touch with your insurer or the broker if you have any questions about the terms and conditions. The bayzat customer service team is always here to help, you can contact us here with any questions you have.
Types of Claims
Most insurance plans offer direct settlement. This means that you will not have to pay the bill yourself; rather, the hospital or clinic will deal with the insurance company directly to receive payment. However, there is always a direct settlement network, which means that there is a list of specific hospitals and clinics where you are eligible for cashless claims.
The second type of claim is reimbursement basis, which means that you pay the bill and the health insurance company will reimburse you. Most policyholders try to avoid the hassle, and only go to hospitals and clinics within their network. There are a few points to consider with regards to reimbursement:
- Preauthorization is required for some procedures, otherwise you will not be covered, neither by direct settlement nor reimbursement.
- Certain hospitals or clinics may be excluded from reimbursement, meaning you will have to pay the full cost.
- Many times, only a certain percentage of the treatment is reimbursed if it is outside the direct settlement network.
- Some health insurance providers do not cover any treatment outside the network, so make sure you double check your policy.
- A little known fact is that the amount you are reimbursed is not based on the actual cost you paid, but rather on the cost of the same treatment at the hospitals and clinics in your health insurance plan’s network.
Filing a Claim for Reimbursement
Most claims are denied because of the policyholder’s lack of knowledge about their plan. Filing a claim involves a lot of paperwork, but there are a few points to keep in mind. Firstly, you should keep every single piece of paper. This includes bills, prescriptions, receipts and x-rays. Stay on the safe side and don’t throw anything away until your claim is processed. Once you have submitted the documentation and forms, keep a record of all communication with the insurance company in case there is a dispute.
bayzat was created with the aim of providing UAE residents with more transparency when it comes to health insurance. It is a great idea to compare health insurance plans before you make a decision to avoid being stuck with a policy that makes filing claims a hassle.