Generally speaking, the commercial health insurance reimbursement process of most insurance companies roughly includes four steps:
1, report the case in time. In the event of an unfortunate insurance accident, the applicant should report the case to the insured insurance company in time. Generally speaking, it is reasonable for an insurance company to refuse to pay compensation after reporting the case beyond the time specified by the insurance company.
2. Accept the claim. The beneficiary shall submit the claim materials according to the terms or requirements agreed in the agreement, and the insurance company shall accept the claim if it meets the acceptance requirements.
3. Claim review. Professional claims adjusters of insurance companies review cases and make claims decisions.
4. If the reimbursement of commercial health insurance is approved by the insurance company, the insured can get compensation within a few working days.
What materials should be prepared for commercial health insurance reimbursement?
Different commercial health insurance compensation events need to prepare different materials. Generally speaking, commercial outpatient medical insurance reimbursement needs to prepare three materials:
1. Copy of the identity certificate of the insured;
2, the original receipt of medical expenses (including outpatient medical charges);
3, medical manuals, prescriptions, checklists, laboratory tests and other originals.
The materials to be prepared for reimbursement of medical insurance for commercial hospitalization are:
1. Copy of the identity certificate of the insured;
2, copy of medical records, discharge summary, need to be provided by the hospital and stamped;
3, the original receipt of medical expenses, the original details of hospitalization medical expenses;
4, medical manuals, prescriptions, checklists, laboratory tests and other originals;
5. If there is social security reimbursement, a social security reimbursement list shall be provided.
To sum up, the reimbursement process of commercial health medical insurance mainly includes four steps: timely reporting, accepting claims, reviewing claims and obtaining compensation. In addition, the materials that need to be prepared for reimbursement can not be ignored. It can make the procedure easier to make reimbursement after understanding it clearly.