Remember These Points When Making Health Insurance Reimbursement Claims

The process of getting reimbursement claims is complex, unlike a cashless facility. In addition, since it requires the insurer’s approval, the customers often experience several issues, including claims rejection.

The healthcare cost in UAE is rising every passing year, and you have to pay the bill from your pocket in case of the reimbursement process. Now, waiting for your insurer to pay you the sum assured is a long process.

So, before moving ahead with the pointers, remember it is essential to comprehend what a reimbursement claim is.

The above plans and premiums are for AED 1,000,000 Sum insured for 1 Adult of 30 Years for Dubai city.

What is a reimbursement claim?

In this insurance claim process, you must pay the medical expenses independently. After that, you need to submit a doctor’s certificate, hospital bills and other documents to the insurance company. Following its approval, the insurer will pay you back the amount your insurance plan covers within a certain time. Usually, it takes up to 51 days for the insurance providers to reimburse a claim in the UAE.

Apart from the period, you must know that the insurer may decline your medical reimbursement claims citing a proper reason. In a different scenario, they also may not reimburse the entire amount you spent on your treatment.

So, you need to factor in a few pointers before going ahead to avoid the prospect of rejection.

6 points to keep in mind while filling out reimbursement claims

Following are some important pointers you need to consider to ensure hassle-free processing of health insurance dubai reimbursement claim –

Reimbursed amount

Usually, the health insurance cashless facility is available solely at network hospitals of the insurer. If you avail of medical treatment outside the network hospitals, you have to claim reimbursement. Sometimes, the insurance company may not reimburse the total bill amount.

Hence, you must know the terms and conditions while asking for mediclaim reimbursement to avoid any further confusion.

Waiting period

Many health insurance plans in UAE have a waiting period when the insurer will not process any reimbursement claims. The waiting period varies with the treatments and illnesses. For instance, a health insurance plan for pre-existing conditions usually has a waiting period of 6 months in Dubai.

Likewise, for dental treatment and maternity, the waiting period can be 30 to 90 days. Thus, it is necessary that you check the waiting period for the treatment you are about to receive in advance. Otherwise, the insurer will not approve your reimbursement claims.

Hospitalisation room charges

Your health insurance plan may cover the hospitalisation charges. However, there is a cap on the nightly rate of the hospitalisation room charges. The insurer will not reimburse the full amount if your claim amount exceeds the limit.

Co-pay

In UAE, apart from deductibles, there is also co-pay or co-insurance. While deductibles refer to a fixed amount, you have to pay on your own every time you visit a doctor.

However, a co-pay means a certain percentage of the bill amount you need to pay while availing of medical treatment. Thus, the insurance provider will deduct your percentage and reimburse the admissible claim amount during a medical claim reimbursement.

Usually, co-pay applies to any treatments received outside the network hospitals. Generally, it is 20% of the total bill and any deductible you need to pay.

UCR (usual, customer and reasonable) charges

While you go for medical treatment outside the network hospitals, insurance companies approve or reimburse only a percentage of the total bill. However, they do so based on the UCR rate. For example, your treatment cost outside a network hospital is AED 2000. The same treatment costs around AED 1200 in the insurer's network hospitals.

In such cases, you will only get reimbursement of a certain percentage of AED 1200, no matter what the actual bill is.

Reimbursement process

Lastly, before making a health insurance reimbursement claim, you must know the process for faster approval. Most health insurers allow you to make reimbursement claims online.

However, you must submit all the relevant documents supporting your claim on time. Usually, you need to claim within 7 days of getting the treatment and submission of the documents. If you claim after that period, the insurer may reject or ask to raise the claim anew.

The best way to ascertain that you raise a reimbursement claim on time is by reading the fine print carefully before buying a health insurance plan in UAE. At the same time, another vital point to keep in mind here is the policy exclusions. If you file a claim for any treatment that is out of the scope of your said policy, you will not get the reimbursement for its treatment.

To sum up, insurance providers often reject reimbursement claims if you furnish wrong information while purchasing a plan or intentionally hide your medical history. Otherwise, if you face rejection from the insurer, try to find the reason first.

If you have proper evidence and documents to support your claim, you can further make a reimbursement claim to the insurance provider.