QUOTE(plumberly @ Sep 26 2016, 09:18 AM)
I have been wondering why insurance company will only accept claims for in-patient treatment and not for day patient treatment. For patient's medical claim, doctor may state treatment is in-patient and thus charge a bigger bill. OK for the patient as the insurance company is paying for the bigger bill. Not really the case.
* patient does not incur higher cost with the in-patient bill
* insurance company pays the bill
* doctor gains extra $$ for no extra work
* insurance company profit is less, increase insurance premium
* patient pays higher premium
I may be wrong with my logic above, patients pay more in the end with the in-patient policy.
See The Star article below.
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Can someone in the insurance field help me on why only in-patient claims?
Only the more serious treatments (ie in patient) are covered?
I had a not-so-nice encounter with this day & in-patient thing at the medical center here recently.
Cheerio.
A good rule-of-thumb/guide to whether or not an admission/treatment is claimable (applies to day procedures as well):
1)
There is a treatment done, and the treatment is medically necessary.
Examples: dengue, slip disc, cardiac arrest, broken bones, injury due to accident, organ transplant, all critical illnesses, etc.
Some cosmetic advertisements that I noticed on the radio recently are marketing their procedure as a "treatment" for freckles and/or dark spots. These are categorized under aesthetic procedures and are not claimable.
2) What constitutes an injury due to accident:
It is sudden, violent, and/or external impact.
Examples: I waving goodbye to my uncles and aunties. Smart sibling of mine slam the car door shut. My fingers broken.
Verdict: it is sudden, it is external impact. Claimable.
3) Majority of rejected claims are due to incomplete documents.
Example of documents: medical report, claim forms, original receipts, itemized billing, credit card deposit receipt (if applicable).
Is this helpful? Let me know!