How to make a health insurance claim? The key points you need to know
If you want to make a health insurance claim, the following steps you need to understand.
 
1. Consult your GP’s family doctor or emergency doctor
 
The first step is to consult your family doctor when a health condition has arisen, to discuss the condition and to plan the next medical procedure (such as specialist consultation, imaging, tests). All of the main insurers, such as AIA, NIB, Partners Life, require that you must be referred by a GP to the next medical procedure. Sometimes, the patient may go to a clinic that offers emergency consultation. The doctor in urgent clinic actually acts as a GP.
 
2. Take the copy of referral letter
 
It is important to take a copy of your Referral Letter, this is a necessary document for claims
 
This referral letter should show the information below, 
  • Sysmptoms or illness started date☆
  • Sought medical advice date☆
  • Any relevant medical history☆
  • What is the next step in the recommended medical service ☆
A well-informed letter can greatly speed up the claims process!
 
 
3. Pre-approval or Reimbursement
  • Pre-approval.
Once you take the referral letter and book your next medical service, you need to do pre-approval! Your insurance adviser usually help you complete the processes. Once your claim is pre-approved, you can send the pre-approval letter to your medical provider. Then they won’t charge you immediately. You can ask the insurer to pay your bill directly.
 
  • Reimbursement
Sometimes, you don’t have enough tinme to do pre-approval. So, you may pay the bill on your own cost. Then, you should submit referral letter, receipt of medical service, relevant medical notes. The insurer will pay to you later. Please be aware that by paying for your treatment and seeking reimbursement afterwards there may be costs that are not covered by the policy including for example your excess or costs that exceed the maximum cover. If you seek prior approval insurers can let you know what these are before any treatment takes place.
 
JIC Insurance – Yuki.sun@jic.co.nz

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