Case Study: Steps to Claim Your Surgery & Hospitalization Bills

An article by Mathias    No Comments

In a recent post, I shared that my mum had been diagnosed with cataract in both eyes and would require surgery on both of them in order to rectify the problem.  It was estimated then that the surgery would cost about $4000 per eye, and so both eyes together would cost around $8000.  Thankfully I already got her insured with a comprehensive hospitalization coverage by Great Eastern more than a year ago.  It only took a phone call to my insurance agent to confirm that cataract is covered by her policy (thankfully!).

Now that I know her bills can be claimed back from the insurance company, the next thing to do is to find out the claiming procedures.

Steps to Claim Your Bills

1. Keep all receipts related to the surgery.  This would be the receipt for the hospitalization/surgery, and should include all pre/post-surgery consultations, check ups and medications.  If you’re not sure what exactly is claimable, just keep them all and check with your agent later.  For our case, all pre/post consultations are inclusive and will be refunded back to us.
2. After the surgery or when you’re checking out of the hospital, you would be presented with a preliminary bill.  Before making any payment to the hospital, make sure you inform the billing officer that the patient (my mum) is insured, and find out if they have an electronic filing system to your insurance company.  If they do, make sure they file the bills directly to the insurance company.  This will greatly save you processing time.  The insurance company would then pay a portion of the bill back to the hospital, and the hospital would then refund you that portion when they issue you the final bill.  This is expected to be mailed to you a few weeks later in the form of a bank cheque.
3. Once you received your final bill, contact your insurance agent, and forward to him all the receipts that you have kept, together with the final bill.  He will then process them for you, and help you to claim the outstanding amount.  It will take a few weeks for the processing and you can expect to receive the remaining amount refunded back to you within the month.

Using my mum’s cataract surgery (left eye only) as an example, we paid $1563.78 in cash and $2450 via Medisave during the preliminary billing.  When the final bill was mailed to me, it included a bank cheque of $916.19. We were subsequently refunded with two bank cheques of $101.12 and $658.83, together with $2444.38 credited back to our Medisave.

Medisave Scheme is a national healthcare savings scheme designed to help members pay hospitalisation expenses incurred in Class B2/C wards in restructured hospitals. Medisave savings can also be used to pay for certain outpatient treatments like chemotherapy, radiotherapy and dialysis. You can use Medisave savings to pay for your own or your immediate family members’ hospitalisation expenses, day surgery and selected outpatient treatments.

When I first saw the billing numbers and the refunded amounts, I was rather confused.  I could not easily tell which refund is for which component, and why some of the numbers do not match.  So I entered all the numbers into the spreadsheet, and positioned them as money paid out versus money received for both cash and Medisave.

Now it’s much easier to read, and you can tell that I’ve managed to claim back 100% of all cash paid out.

For Medisave, there is a residual amount of $5.62 which, as explained to me by my agent, is the meal consumed by my mum after her surgery (she was given fish porridge).  My agent further explained that meals consumed for day surgeries are not covered under the policy.  The meals would only be claimable if she was warded.

As of today, my mum has completed surgery for both eyes (in fact she did her right eye surgery today), and I’ve managed to claim back the expenses for one eye thus far.  Even though the procedures and claimable amount for her right eye would be the same, I would still provide an update here at a later date for closure.

I hope this has been able to provide you with some guidance and clarity on how to go about getting your claims.  This is a very important step, and you should make sure you do it right to ensure you do not face any cashflow problem when providing the best medical attention for your love ones.  If you’re new to insurance and are not sure what you need, you can read the article, What is Health Insurance? as a good way to get started.

Cheers!

No related posts.