INSURANCE PRE-APPROVAL, PAYMENTS AND CLAIMS FAQ
Payments, claims and pre-approval handling
a) Do I have to pay when I visit a doctor? What’s the difference between ‘pay and claim’ and ‘direct billing’?
b) How do I file a claim?
c) I will get surgery next week. My doctor asked for a letter of guarantee. Not sure what he means.
d) What medical care type requires a letter of guarantee?
Well, some confusion here, but basically: if your insurance company or TPA supports direct billing and your doctor agreed with them to become a direct billing provider, you will not have to pay to receive medical care (according to your plan benefits).
Instead your doctor will be paid directly by the insurance company. This is what directs billing means.
By now it’s clear that an exhaustive direct billing provider network should be a key factor choosing your international health plan as direct billing makes your life as an expat easier: you will only have to show your policy member card to your doctor.
If no direct billing is available, its pay and claim which means you have to pay the full amount to your doctor and request a refund later on.
To be reimbursed for paid medical care, a claim form, usually available online, has to be completed. Enclose your dentist’s report and invoice and submit all documents to your insurance company or TPA.
Within a specified time interval (usually 5 working days) you will be reimbursed.
My doctor asks for a letter of guarantee as I will get surgery next week. Not sure what he means...
A letter of guarantee proofs you are covered for the upcoming treatment.
For this, a pre-approval procedure has to be followed: first, ask your doctor a medical report explaining the medical motivation for your surgery, enclose with a completed online pre-certification form and submit to your insurance company or TPA.
According to good medical practice and your plan’s benefits a doctor from the insurance company or TPA will verify and acknowledge the requested treatment. If approved, a letter of guarantee will be sent to your doctor.
These require a log:
- prenatal care and childbirth
- outpatient day case surgery
- inpatient medical care
- chronic conditions
However check your policy for any exceptions.
Outpatient treatments usually don’t require approval, but some outpatient healthcare providers might ask you to provide a letter of guarantee to assure you are covered and if your benefit limit hasn’t been exceeded.