Hospitalization records insurance companies will be so inquired, will cast the parties (policyholder insured) to sign a consent to access hospital records consent form, the insurance company can go to the hospital to retrieve the relevant data.
The insurance company has a department called "contract investigation" department, they are mainly responsible for claims evidence, the customer will be reported to the insurance information, and then they will be based on the information to the relevant hospital medical insurance office to verify.
The hospitalization information is not perfect yet, but the insurance companies and hospitals will be connected to each other in the future, which means that the insurance will be more and more stringent
Whether the insurance companies have all the information can be found out
Not necessarily. In earlier years, hospital medical records were handwritten, and the format and preservation were not very standardized, so it was time-consuming and laborious to investigate, and it was inevitable that something would slip through the cracks. But that's less and less likely now.
If you use your health insurance card in the process of seeing a doctor, the information related to buying medicine, seeing a doctor, and having a physical exam will all be recorded. I often come across some friends inquiring because they helped their family members to buy high blood pressure, diabetes and other such medicines, and end up with disputes when claims are made.
Beginning April 1, 2017, the state implemented the interim norms for the management of electronic medical records. It requires outpatient medical records to be kept for a minimum of 15 years and inpatient medical records for a minimum of 30 years, and doctors have to follow a standard template when writing electronic medical records. When you took what medication, what disease you had, what medical images you had, what lab tests you had, all of them will be kept in a complete record. When insurance companies do this kind of investigation in the future, it saves time, effort and efficiency, and the possibility of missing information is greatly reduced.
Expanded Information:
Hong Kong Insurance Company Investigation Channels
All insurance companies have a special department that is responsible for investigations after an accident. There are two main ways to be informed of the policyholder's past medical history: one is through the social security or the new rural cooperative medical care to check the medical record, and the other is the mainland commercial insurance claims record. The former of these is the main channel of investigation at present.
The investigation process of insurance is roughly like this:
1. After an insurance accident, the customer applies for a claim, and needs to provide the insurance policy number, proof of identity, proof of diagnosis of the disease, a list of medicines, and treatment records.
2. After receiving the customer's claim, the insurance company will take the customer's place of work and residence as the center, and go to several major hospitals in the vicinity, as well as the local major hospitals, to retrieve outpatient and inpatient records. If nothing suspicious is found in the records and the claim amount is small, it is usually paid out quickly.
3. If a claim occurs within 5 years after the policy has been taken out, if the amount of the claim is particularly large, or if the claim is filed just after the waiting period, the insurance company will further expand the scope of the investigation. Including the customer's physical examination records, medical insurance card spending records, and more local hospital records.
4. For customers whose domicile is not in the place where they are insured, the insurance company will commission a professional insurance investigation organization to run to your domicile and investigate the customer's record of visits to major local hospitals.
Many of my former clients have asked me if the Hong Kong insurance companies have no local branches to investigate.
If the insurance company wants to check, they can. The reason is that in the insurance industry, there is a kind of organization called an insurance investigation company. The vast majority of Hong Kong insurance companies have long-term cooperation with professional insurance investigation companies. As long as there is a customer's identity card number and work unit, the physical examination, consultation and hospitalization records in the tertiary hospital can be checked out.
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