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!
Many thanks.
What about something which develops overtime and later needs treatment, say, skin rash which later gets infected?
Thanks.
P/S Wonder why do some clinics at the start ask whether payment is by cash or via claim? Don't think it is because they need to know for their payment process.