Helping out clients with medical claims is a pretty cool part of my job. Learning about medical conditions I've never even heard of is often fascinating, but the real reward is when the claims get accepted. Sometimes though, clients would rather by-pass our office, as their claims can be extremely personal in nature.
In this digitally advancing world, it is now even easier for you to be able to handle your own minor claims without having a third party (i.e. me) knowing about your 'secret men's business' (or secret women's business, whatever the case may be). You can download a Claim Form from our website and send it direct to your provider, and Sovereign even have a cool Online Claim form which is really simple to follow.
It helps to know the in's and out's, so here are some tips:
We always recommend gaining prior approval, even for specialist consultations - that way the insurer has already assessed the claim, and you are certain that you will be covered.
The exception (and there is always one!): Accuro don't generally do prior approvals for treatment/investigations that are likely to be less than $1,000.
It's not a quick process. The majority of providers have a processing time of up to 10 working days, depending on their caseloads.
The exception: if you have an urgent prior approval, it is best to contact us … sometimes it's not what you know, but who you know.
Every provider will want a referral letter. If this is really detailed, including the history of your symptoms/treatment/investigations and when you first sought treatment it will usually be enough to process the prior approval/claim without having to have the medical report section completed on the forms. A handy tip - if you are going to the GP with an issue that you thinkmay be referred on for further investigation, take a claim form with you. That way, you can get your GP to complete it there and then, without having to return at a later date to get this filled out.
The exception: Accuro will want a medical report to be completed for every claim if the policy has been in force for less than five years.
Routine screening is not covered. If you are going for a mole map just because you can, or feel like having a mammogram (as unlikely as that is!) your medical insurance will not pay out. However, if there is a specific issue, and your GP refers you on to have these tests, then you will be covered.
The exception: Some insurance providers offer a loyalty benefit to cover part of the costs for these tests - please check your specific policy wording (we can send these to you).
BRAVEday will fight for you at claim time … so if you are having trouble with a medical claim, we are always here to help. If you have any questions, or need any help completing your forms just get in touch.