In view of the shortcomings of the traditional claim service model, a new claim model-direct payment claim model came into being, which improved the customer experience, reduced operating costs and improved efficiency for insurance companies.
The traditional claims service process of health insurance is as follows:
(1) Customers spend money in health care institutions, and health care institutions issue documents, invoices and other materials to customers.
(2) The customer is responsible for the management and preservation of invoices and other materials, and applies to the insurance company for claim settlement at a single time, at a fixed time or with a certain amount.
(3) The insurance company files a case according to the materials provided by the customer, and transfers the claim after the claim is passed. If the audit fails, the user needs to supplement the materials and re-audit.
(4) For the claims that have been approved, the insurance company will transfer the money to pay the compensation.
The service mode of direct payment claims for health insurance is as follows:
(1) The customer receives the prepaid card after insurance.
(2) Customers do not need to pay cash in advance when spending charge cards in health institutions.
(3) Health institutions shall keep customer documents and submit invoices to direct payment and claims settlement institutions on a regular basis.
(4) The direct payment claim settlement institution shall review the invoice and hand it over to the insurance company after sorting.
(5) After examination and approval, the insurance company directly transfers money to the health institution.
In the process of direct payment of claims, the customer's advance payment is converted into the advance payment of health institutions, which improves the customer experience. For health institutions, there is no need to issue invoices and other materials frequently. For insurance companies, due to the fact that the direct payment claims agency has sorted out invoices and other materials, a large number of customers' claims can be completed at one time, and the cost is greatly reduced.
This mode is also the claim mode adopted by Ipoh Health Management Co., Ltd. Ipoh Health has joined hands with more than 37,000 health institutions across the country to continuously improve the service process of health insurance by means of information service, greatly improving the user service experience and promoting the sustainable development of health insurance. While deepening the claims service, the health insurance link was officially released.
Jianbaotong became the first health management tool in China to provide free video consultation. By providing users with free health management services such as health monitoring and health cloud files, Ipoh Health has created a complete and funny health management ecosystem, which can meet the needs of users for daily monitoring, consultation, drug purchase and insurance payment in one stop.