Usually, there are three main ways for insurance companies to obtain the medical records of the insured:
1, investigate social security medical records
Social security card is a personal card. As long as it is used, all personal medical treatment and drug purchase will be recorded one by one, such as pharmacy drug purchase records, hospital outpatient or hospitalization records. Therefore, it is recommended that the medical insurance card should not be easily borrowed!
2. Investigation of hospital medical records
Investigators of insurance companies will check the medical records of hospitals and even other local hospitals or clinics, and make comprehensive analysis and judgment based on basic information such as medical records, complaints, medical records, treatment and doctor's advice.
Article 53 of the Regulations on the Administration of Medical Institutions stipulates that the retention period of outpatient medical records of medical institutions shall not be less than 15 years; The retention period of hospital medical records shall not be less than 30 years. The medical records of clinics should be kept in appropriate places and personnel for at least 65,438+00 years. "So it is very difficult to conceal the medical history. After all, insurance companies are not vegetarian.
3. Enjoy peer information.
Most insurance companies need compensation from the other side. For example, setting up a resource sharing or peer exchange group can reduce some workload and improve investigation efficiency.
In addition to the investigation of the above medical records, you may also meet people related to the compensation case, even relatives and friends around you; The medical examination institution shall check the medical examination report; Investigate government medical institutions, including health stations and family planning commissions. The investigators may be the indemnity personnel of the insurance company or the outsourced third-party personnel (insurance assessment company).
The purpose of claim investigation is to restore the truth of insurance accidents, investigate insurance fraud and safeguard the interests of insurance companies and benign customers. With the rise of payout ratio caused by malicious insurance, insurance companies have to consider adjusting their rates, and the premium increase will ultimately be borne by the insured, which is unfair to benign customers.
I hope the above answers can help you!