You’ve done the sensible thing—taken out private health insurance for you and your family to make it easier to access health services and help cover medical costs. But do you know what to do when it comes time to claim?
The majority of health insurance queries we receive from clients relate to prior approvals for medical procedures and whether or not the procedure is covered by their insurance policy. Thankfully, most insurers generally require the same information in order to begin the health insurance claim process.
With that in mind, here are a few tips to keep in mind if you have been referred for further treatment/investigation by a medical professional:
Get a referral letter
All insurers generally require you to provide the initial referral letter.
If you don’t have the referral letter, then get the referring professional to complete the medical questionnaire section on the claim form.
Many GPs have set days for paperwork, so you may not get the referral letter straight away.
It’s always a good idea to ask your doctor for a copy of the letter right then and there. Many GPs have set days for paperwork, so you may not get the referral letter straight away. While this isn’t ideal, you will at least have a timeframe for either the completion of the medical questionnaire or referral letter.
Provide an estimate of cost
Insurers generally expect you to provide an ‘estimate of cost’ for your treatment. Please be assured that medical providers should be able to give you this information easily and quickly, as it is a standard requirement.
Clients sometimes comment that they never needed to provide this information to their previous insurer, or that their friend/colleague doesn’t need to provide this level of information. But it is important to remember that each insurer sets its own rules and if they’ve asked for it, you need to supply it.
Provide clear copies of documents
If you’re unable to scan a document and need to provide photos of invoices, receipts and medical letters, then it is important to ensure that all relevant information is captured, especially the letterhead and date.
It is important to remember that each insurer sets its own rules and if they’ve asked for it, you need to provide it.
If these aren’t clearly visible the insurer will request this information to be resent.
Urgent prior approvals
In the case of an urgent prior approval, get in touch with your insurance adviser as soon as possible. Many insurance companies assess claims based on the date they were received, not the date of the procedure. So the more time that you allow for an assessment the better, especially if the insurer requests additional information.
Hopefully some of these tips will help to make your health insurance claims process as seamless as possible.
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