What is a reimbursement claim?

A reimbursement claim refers to the claims made against expenses incurred towards the treatment of an illness. The insured must have notified the insurance company before a planned treatment and within a reasonable time frame during an emergency treatment.

Filing claims is an important part of using your health insurance. Will the insurer honor the claim? Is it covered by the policy? Many questions come to mind, making it seem like a complicated process, although it doesn’t have to be. With the right knowledge, filing a claim can be very simple.

Important things to keep in mind

Let’s take a look at some tips that will help ease your mind when filing a reimbursement claim.

1. Before filing an insurance claim, gather all the medical reports, hospital bills, receipts, etc. that are related to your hospitalization and treatment. This includes those that you obtained during the thirty days before your hospitalization.

You should also keep all those medical reports, bills, and receipts pertaining to the two-month period after you were discharged from the hospital. These documents should only be related to the treatment for which you were hospitalized.

In addition to the document number and date, the medical reports, bills, and receipts should have the name of the patient, name of the hospital or service provider, name of the consultant who provided the treatment, name of the products purchased or services availed, serial number, batch number, quantity, costs of the products, the details of taxes (if any), and finally, the signature of the person authorized to sign on behalf of the establishment.

2. After collecting the above documents, arrange them from latest to oldest. It is best to come up with a way to find them when needed. One of the ways to do so is to number them and store them in a secure location.

3. You must submit the originals of all the medical reports, discharge summaries, consultation sheets, bills, and receipts. The insurance company will reject your claim if you do not attach the original documents to your claim.

4. It is a good idea to keep photocopies of all your medical documents for your reference. If the documents you submitted get lost or misplaced, you can use these copies to prove that you underwent treatment.

5. Remember to provide the right details in the form. There may be queries about your health insurance coverage, the medical expenses for reimbursement and the purpose for which you were hospitalized. Also provide the required proof of identity and a few other personal details required. Provide up-to-date information so the claim is not rejected. You and the consultant who treated you should sign the form. The hospital should also authenticate the form.

When to submit your claim

According to the rules of almost all health insurance companies, reimbursement claims must be filed within 7 days after completion of treatment or discharge from the hospital.

Documents needed for claim submission

The documents that you must attach with your reimbursement claim are classified into two categories: medical documents and policy documents.

While you are supposed to attach the originals of all documents, you must also send a copy of the following:

a) Medical Documents

The medical documents you must attach include the discharge summary that contains the patient’s name, time and date of admission, time and date of discharge, investigations conducted, the main diagnosis, the consultation sheets, prescriptions, pharmacy receipts, and cash memos.

In case of a surgery, documents showing the consultation fees paid to the surgeon, surgery charges, etc. should be attached.

Make sure to attach a certificate obtained from the medical practitioner or the surgeon stating that the patient has been treated. If the discharged patient will be cured after taking the prescribed medicines for a few more days, that should also be mentioned in the certificate.

b) Policy documents:

The policy documents you must attach should include your previous policies. You must also provide the inception date of the current health insurance coverage.

Filing the claim form

Review your claim form and all the documents before submitting them.

Remember the following to avoid rejection of a claim:

1. Do not include personal items you have purchased for your comfort. If your reimbursement claim includes the food bills of a relative or friend who was with you during your hospitalization, the insurance company will not reimburse those expenses.

2. Have a good understanding of your health insurance policy in the UAE, because most rejections happen only because policyholders have not read the policy document. If you do not know what is not covered under your policy, you may accidently add them to your reimbursement claim, and the insurance company may reject your claim.

3. Know the conditions pertaining to pre-existing diseases because there will be a waiting period for these diseases.

4. Most rejections happen due to non-disclosures, incorrect disclosures, or partial disclosures. Facts like your age, occupation, the insurance policies you already have, your income, pre-existing conditions, major ailments, etc… are very important, and you should disclose all these details.

5. If you depended upon another person to fill in your proposal form when buying your health insurance, there is a chance that incorrect or missing information is being submitted in the proposal. Read the policy document carefully when you get it, and if there are any discrepancies, contact the insurance company without delay and rectify them.

6. Your insurance company may reject your claim, saying there was no necessity for the treatment or the procedure. That is why you should get a certificate from the doctor who treated you that states that the treatment or the procedure was necessary.

7. Try to control expenses related to your treatment. Just because you have a health insurance policy, you cannot assume that whatever you spend will be covered.

8. Make sure to check your claim form and the attachments before you submit them.

Follow the tips above to make sure that you do everything possible to get the insurance company to honor your reimbursement claim in the UAE. Good luck!

 

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