Starter: Wen Wen Da Bao Belle
An insurance self-media that can contact the owner of the public number
Hello everyone, I'm Wenwen Da Bao Belle, your heel insurance blogger.
After we all buy insurance, we must think that it is best not to use it;
But if you really use it, I still hope to get the claim payment smoothly.
In the claims process, there will be many details that need our attention.
This article will help you sort out some common claim considerations.
I hope you never use it, but if you do, don't panic.
01
What hospital to go to?
When you see a doctor, go to the hospital you are going to and must meet the terms and conditions.
If you go to a hospital that does not meet the requirements, the insurance company can refuse to pay for it.
Generally speaking, the requirement is to go to the general department of a public hospital of level II or above.
There are also some products that will be exempt from liability in specific areas or hospitals, and these cannot go:
Before seeking medical treatment, you must understand whether the hospital you go to meets the terms and conditions.
How to judge the grade and nature of a hospital?
Method 1: The official WeChat account of the National Health Commission "Healthy China"
Through the "Inquiry Platform" - "Institution Inquiry" in the menu bar, select the region, enter the name of the hospital, and you can see the specific level of the relevant medical institution.
Method 2: Lilac Garden's public account "Medical Garden Hui"
Click "About Us" in the menu bar, then select "National Hospital", enter the name of the hospital to query, you can see the level and nature of the hospital at the same time, which is very convenient.
02
Pay attention when writing medical records
Medical record descriptions are very, very important to get an insurance claim!
In many cases, claims are denied because the medical records are incorrect.
First of all, when describing the condition with the doctor, do not exaggerate.
When some friends see a doctor, they are afraid that the doctor will not pay attention to themselves, and frantically exaggerate their condition with the doctor——
I had hepatitis once in elementary school and told myself that I had a history of hepatitis B for 30 years.
Descriptions such as "XX symptoms have been present for XX time" or "patients complain of discomfort in XX site for up to XX", try not to let the doctor write it in the case.
When making a claim, if the insurance company reverses the time of occurrence of the disease and finds that it is a symptom that existed before the insurance application or during the waiting period, it is very easy to cause a claim dispute or even deny the claim.
Especially some friends' discomfort symptoms are not actually so long, just want to attract the attention of the doctor to say so, this reason leads to the refusal of compensation is really a loss.
When you communicate with the doctor, you can state objectively, and don't process something you are not sure about.
In addition, remind that if it is caused by an accident, be sure to describe the time and cause of the accident, and let the doctor record it in the medical record.
The description of the medical record will be used by the insurance company to determine the cause of the insurance.
For example, falling down the stairs, saying "accidentally tripped" and "suddenly dizzy when going downstairs, and then falling", the results of these two descriptions are definitely different.
The former is an accident, the latter is a fall caused by illness, if the latter's medical records are used to apply for accident insurance claims, the insurance company can legitimately refuse to pay.
PS: Our principle is to seek truth from facts, and it is recommended that you do not process subjective ideas too much and say things too exaggeratedly, instead of letting everyone lie ha.
Second, carefully examine the medical records after getting them.
After getting the medical records, we also need to pay attention to whether the content filled in by the doctor is true and accurate, and remember to let the doctor modify the medical records in time if you find a clerical error.
During the examination, in addition to paying attention to whether there are any errors in basic information such as your name and the date of your visit, you should also check whether the doctor's records are correct and try not to use inaccurate and unfavorable wording.
For example, because you eat something bad to go to the doctor, the doctor may directly write "gastritis", which may have a certain impact on underwriting or claims.
03
If you have medical insurance, you must use medical insurance first
Many medical insurance products, if they buy a social security version, then when making a claim, they will be required to use medical insurance overall reimbursement first (with the exception of buying the no social security version);
If it is not first reimbursed by Medicare, the reimbursement rate of commercial insurance will decrease.
Therefore, when everyone seeks medical treatment, try to use medical insurance settlement first.
Remember to file for medical insurance in different places.
04
Report the case in case of danger and keep the relevant information properly
Claims process:
Reporting a crime in a timely manner is always the right thing to do.
There are also some million-dollar medical insurance products, the "cancer drug purchase liability" is directly paid by the insurance company and sent to the door, or the drug purchase certificate is used to collect the drug at the medical institution designated by the insurance company, and it does not support self-purchase of drugs and then reimbursement afterwards.
After reporting the case, the insurance company will send us the specific claim guidelines and the information that needs to be submitted in the later stage, and we can prepare the information according to the application steps to avoid running back and forth to the hospital due to incomplete information in the later stage.
The information required for common insurance claims is as follows:
What materials to prepare specifically depends on the specific insurance situation, the requirements of the insurance company.
Friends who have insured here in Wenwen Dabao Belle, remember to contact me as soon as possible, and timely have the claim assistance of professional insurance brokers, which can make the claim process more silky.
PS: About the limitation of claims
Insurance claims are time-barred, like life insurance claims are usually five years, non-life insurance claims are two years.
In other words, life insurance cannot be claimed after five years, and non-life insurance cannot be claimed after two years.
The [statute of limitations] article can also be seen in the insurance terms:
05
Regarding the claim settlement, Wenwen Dabao Belle has been writing articles to convey more information and some noteworthy key points.
Claims is a science with many details, and it is usually very confusing to understand when it comes to insurance, and it is not necessarily time, it is best to keep these general precautions in mind after buying insurance.
At the same time, do not ignore the importance of professional insurance brokers to help you with claims assistance, professional things should still be handed over to absolutely professional people to do, their help can play a role in half the effort.
However, I still hope that these knowledge points are only everyone's theoretical knowledge in the end, and it is best never to use them in practice.
Finally, I still remind everyone that after the insurance, before the claim, contact Wenwen Dabao Belle as soon as possible.
I've always felt that my work is only valuable if the insurance I sell really works.
Wen Wen Dabao Belle will help everyone with the whole process of assisting with the claim until you receive the claim payment.
Of course, what Wenwen Dabao Belle hopes more is that everyone can never use insurance, and live a lifetime of health and safety.
If life is like drinking water and knowing themselves, then insurance is more like a safe protection when knowing the cold and warmth.
When the risk comes, may we all have the confidence to deal with it calmly.
Wen Wen Dabao Belle has always been there.