Making An Expatriate Medical Insurance Claim

By Author: Andrew Wilson
Total Articles: 9
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Please be aware that this info is supplied as general advice only. All insurance providers/providers have their own separate claims procedures and their Policy Wordings must be consulted for precise claims advice.
Although each international medical insurance provider has their own claims processes, as a "rule of thumb" there are a lot of similar themes that run through most, if not all, plans. It is vital to be sure that policyholders are familiar with their insurers own claims procedure - if they are not followed correctly claims might be delayed or perhaps refused.

If an expatriate health care insurance plan posseses an excess or deductible this will be factored in when the claim is settled (ie the insured person may still have a liability to a portion of the claim as agreed when obtaining cover). Similarly, some policies and benefits employ a system of "co-insurance" or "co-payment" whereby the insured is prepared to pay for a set amount of the expenses, instead of a set monetary amount applicable either per year or per claim.

General Information

Inpatient/Daypatient Claims

These kinds of ...
... claim can be defined as those where there is a requirement for treatment in hospital:

Inpatient Treatment - treatment in a hospital where an insured person is admitted and takes up a bed for one or more nights.

Daypatient Treatment - treatment at a hospital where an insured person is admitted and occupies a bed, but does not remain overnight.

It is a condition of expatriate medical insurance policies that inpatient/daypatient claims are pre-authorised. This means that the insurer/provider should be contacted in advance of treatment and informed about what treatment is needed and also at what hospital it will take place. The insurer will then contact the medical facility and arrange for any bills to be settled directly by them, thus saving clients from paying out potentially large treatment charges and then reclaim the money from the insurance provider.

Worth noting is the fact some insurers will enforce fees and penalties on customers for inpatient/daypatient claims that aren't pre-authorised. Whilst the claim may still be settled, it may only be at a percentage of the overall cost (generally this is at about 80%).
There are, needless to say, instances where pre-authorisation just isn't practically feasible - primarily in the event of accident and emergency. We at Xact Expat always recommend to our customers that they keep a copy of their insurance plan documents or membership card with them plus make certain that friends, family or co-workers also have access to them should the client be unable to contact the insurance company.

Outpatient Claims

This type of claim is defined as:

Outpatient Treatment - treatment at a hospital, consulting room, or out-patient clinic where an insured person will not occupy a bed.

Under expatriate medical insurance coverage programs, this type of treatment will not typically have to be pre-authorised but has to be settled by the policyholder and then claimed back from the insurer.
It is, however, always a good idea to contact the insurance company in advance to check that the required treatment is covered under the terms of the policy.
In order to do this, original itemised invoices and receipts need to be obtained from your doctor, therapist etc at the point of treatment/payment. In addition to these documents a claim form needs to be completed by both the insured person and the treating doctor (note that many insurance providers will not reimburse any charges generated by the doctor for completing a claim form). These claims forms are available either from the insurance company or can be obtained from the downloads page at www.xactexpat.com.
The completed claims form, together with the appropriate original receipts and invoices should then be sent to the claims section of the insurance carrier as soon as possible (many companies will only accept claims submitted within a certain time from treatment being received - frequently six months).

Upon receipt, the claims department will assess your claim and refund suitable repayments either by cheque or bank transfer. They may however need further medical reports or details before they will make the payment.
Should treatment be needed on an ongoing basis, new claim forms aren't necessarily required for each group of bills and receipts provided that the insurer is advised that they correspond with an active claim. It is however possible that if the treatment continues beyond six months the insurance carrier may need either a new claim form or an up to date medical report (that they might not be prepared to pay for).

Andrew Wilson
Director
Xact Risk Solutions
www.xactexpat.com

Andrew has over twenty years experience providing the best insurance solutions for his clients needs. A recognised expert in the field of international medical insurance, he has helped expats all around the world whether they be individuals, families, groups or companies. Please visit the website at www.xactexpat.com to find out more, or you can get a free, no obligation quote simply by visiting www.xactexpat.com/get-a-quote.html