Health Insurance Claim

I've just been told by my doctor that I've to go into hospital for a minor operation and that the cost will be in the region of 100,000 HKD. I have had insurance covering surgery for a few years and my agent tells me that I should submit the claim after the surgery and ger reimbursed for the costs then. Is this right? Two things really. I don't have 100,000 HKD to pay up front and after the operation, I will find out if it is covered.


Any advice?

This is fairly normal if you haven't completed a "Treatment Guarantee Form" with the insurance company. There are typically two ways of handling an inpatient claim (any claim arising from treatment where an overnight stay in a hospital is needed).


In an emergency situation where there is no prior warning you will normally receive the treatment/surgery and then submit a claims form to the insurance provider after the fact for reimbursement.


However, if you have notice that you will be needing to go in for surgery then you should be able to have the insurance company liasie directly with the hospital to confirm coverage of the surgery (treatment guarantee). In fact, many insurers in Hong Kong have direct settlement options with most of the major private hospitals (Adventist, Sanatorium, etc) which will avoid you having to complete any paperwork whatsoever (but don't forget your deductible - if applicable - as this is something you are responsible for paying).


I'd say that if you haven't completed a treatment guarantee form or had your insurer contact the hospital then yes, you will have to pay up front and then be reimbursed after the fact. But your insurer should actually be able to guarantee the coverage of the treatment ahead of time if you get in contact with them.


A decent resource for you to look at is http://hk.ccw-global.com/health-insurance/coverage/claims/


Out of interest, who is your plan with?

Alexandra, it appears as though you have a local medical insurance rather than an international medical policy. Whilst the local insurance companies do have contracts with many of the hospitals, they normally only offer a cashless hospital option to group company medical plans. Again this is only the case if the annual premium is over a certain amount.


If you had an international medical plan, as scrugby says, you speak to your insurance company and fill in a Treatment Guarantee Form and they correspond with the hospital.


No matter who your insurance company is, they should be able to tell you if you would be covered for the operation or not. You may also consider talking to a manager at the insurance company and explain your situation. Maybe they could help?


If you let me know who the insurance company is I might be able to point you in the right direction as to whom to talk to.


Send me a PM if that is easier.