Starter: Wenwen Dabao Belle
An insurance self-media that can contact the owner of the public account
Hello everyone, I'm Wenwen Dabao Belle, an insurance blogger who is responsible for every customer's claims.
to share an accident insurance claim.
01
At the end of July 2022, the mother of the client's little brother accidentally sprained her ankle while going out.
My aunt didn't think it was serious at the time, so she didn't go to the hospital for medical treatment.
As a result, one day later, my ankle was severely red and swollen and painful, so I went to the hospital for examination.
Because the old man is old, this time the broken foot is quite serious, resulting in a fracture of the left foot dice.
Considering the condition of the elderly, age and other factors, the doctor recommends several follow-ups.
It is said that "it takes 100 days to break the muscles and bones", and the old man's re-examination took about three months to determine that there was no problem.
CT review in August 2022:
CT review in November 2022:
Because considering the long review period, after consulting the aunt's situation, I suggested that the client's little brother should apply for a claim together after completing all the treatments.
In the middle, you can keep the outpatient treatment records, as well as invoices and other materials:
However, it is unfortunate that after the end of the treatment, it is just in time for the epidemic to be released, resulting in a much longer cycle of social security reimbursement.
It will not be until May 2023 that Social Security will complete the claim:
After the social security claim is completed, we start to apply for the commercial reimbursement claim.
After deducting the deductible of 100 yuan, the remaining part, regardless of the expenses inside and outside the social insurance, will be fully claimed:
02
According to Wenwen Dabao Belle's past claim experience, the probability of accidental insurance for the elderly is indeed very high.
Elderly people often encounter situations such as falling down stairs, walking and falling, fish bones getting stuck in their throats, etc., so an accident insurance is very necessary.
When choosing accident insurance for the elderly, we generally recommend that you choose a product with better accident medical protection.
The best reimbursement rules for accidental medical treatment can be "0 deductible, reimbursement without limitation on social security coverage, and 100% compensation ratio".
Because such a product can help solve all the treatment costs after the accident, so that we can treat with peace of mind.
However, it should be noted that many accident insurance products need to be reimbursed by social security before they can be 100% paid, and if they are not reimbursed by social security, they can only be reimbursed by 50%-80%.
This gap is still quite large.
In addition, I also really feel from the bottom of my heart that it is quite necessary to buy an accident insurance for my parents.
For the elderly of the previous generation, in addition to treating diseases, the hospital is also a place where money is like water.
Many elderly people are reluctant to go to the hospital, regardless of whether they are serious or minor.
But now we have both medical insurance and commercial insurance, and if the protection is sufficient, it really doesn't cost too much money to see a doctor.
In this way, the elderly can also go to the hospital for treatment with peace of mind, so as not to drag small problems into big problems.
Moreover, an accident insurance is indeed inexpensive, and it can be regarded as a peace of mind.
In general, the customer's little brother's claim this time is relatively satisfactory.
The medical insurance first reimbursed a part, and then the accident insurance reimbursed the rest of the part, and the two parts added up, in addition to the deductible of 100 yuan, perfectly covered all the medical expenses during the aunt's hospitalization.
03
Accident insurance can cover many things, such as accidental death, accidental dismemberment, and accidental medical liability.
However, in terms of the probability of claims, the probability of death and disability is still relatively low.
The probability of accidental medical use is quite high.
Accidents in daily life, such as cat scratches, dog bites, burns, falls, fractures, etc., can be reimbursed through accidental medical treatment.
According to the annual report of insurance companies, middle-aged and elderly fractures ranked first among the reasons for the payment of accident insurance for the elderly.
When the elderly are older, their legs and feet are inconvenient and their movements are not very flexible, so they are very prone to accidental fractures.
Therefore, from the perspective of claims, it is very practical to choose a product with good accidental medical reimbursement.
In this way, the medical expenses incurred by the elderly for treatment of accidental fractures and accidental falls can be reimbursed through the accidental medical liability of the accident insurance.
Let me share with you the criteria for choosing accident insurance:
(1) Look at the scope of reimbursement
To put it simply, the medical expenses incurred by our medical treatment are roughly divided into two categories:
Expenses covered by Social Security, and expenses not covered by Social Security.
Many accident insurance can only reimburse expenses within the scope of social insurance, but these expenses can be reimbursed by medical insurance for a large part, so the amount left for insurance reimbursement is very small.
And if we want to have a better treatment effect, or recover faster, we need to use self-financed drugs and programs.
Therefore, in terms of reimbursement coverage, you must choose to not limit the scope of social security, and you can reimburse the accident insurance of self-financed drugs and projects.
(2) Look at the deductible and reimbursement ratio
The deductible is the part that is not compensated, the lower the deductible, the better, preferably 0 deductible.
If there is no suitable product with 0 deductible, a 100 yuan deductible is acceptable, but if you want a 300 yuan or 500 yuan deductible, it is not meaningful.
In terms of reimbursement ratio, the higher the better, and it is best to be able to reimburse 100%.
(3) Whether it is necessary to settle with a medical insurance card first
For the vast majority of accident insurance on the market, even if the reimbursement ratio is 100%, it must be settled by the medical insurance card first, otherwise the reimbursement ratio will drop to 60% to 80%.
Because from the perspective of the insurance company, it is definitely hoped that social security can help cover part of the cost.
However, in a very small number of accident insurances, there is no such provision, and even if it is not reimbursed through social security, it will not affect the compensation ratio.
Everyone should also pay attention to this detail.
If you buy an accident insurance when you are out of insurance, you need to settle it in advance with medical insurance, and you must bring your medical insurance card when you go to the doctor;
If you buy an accident insurance product that can be fully claimed without medical insurance settlement, it will be even more perfect.
Finally, I would like to remind everyone that after the accident and 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'm selling really works.
We will help you with your claim throughout the process until you receive your claim.
If life is like a person drinking water and knowing its own warmth, then insurance is more like a reassuring protection when knowing the warmth and coldness.
When the risk comes, may we all have the confidence to deal with it calmly.
As long as everyone has a need, Wenwen Dabao Belle will always be there.