Claims

The way insurance companies handle claims largely influences consumers' satisfaction. There are three ways in which insurance companies cover medical expenses:

1) For in-patient and emergency treatments most insurance companies will settle medical expenses directly with a hospital. For inpatient treatment which is scheduled in advance the insurer normally requires the insured person to complete a 'treatment guarantee form'. The insurer can then contact the hospital and arrange payment direct to the hospital. For emergency treatment the insured should contact the insurer as soon as possible to arrange settlement.

2) In some countries and cities insurance companies set up direct outpatient settlement networks where you can go to an outpatient clinic and the bill is settled directly with the insurer without the individual having to pay.

3) Generally for outpatient treatment the policyholder pays for the medical bill and then submits a claim form to the insurance provider, along with the original receipt. The insurance company will then reimburse the client by sending a cheque, bank transfer or putting money directly into the credit card account.

Complaints regarding Claims

Policyholders are most commonly dissatisfied with the claims due to the delays in reimbursements. This usually happens when the insurance company receives paperwork that is incomplete or incorrect. To ensure prompt reimbursement, it is the client's responsibility to make sure all the documents are in order before sending it to their insurance provider.

Another reason that can prevent an insurance company from reimbursing the claim is the client's pre-existing conditions. If the medical treatment was received for a pre-existing condition (that was not agreed upon by the insurer) then the claim will not be reimbursed.