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Malaysia Health Insurance » Insurance Coverage Summary » Insurance Claims

Malaysia Health Insurance Claims

Anytime treatment is received by an insured, they will need to submit a claim to their insurer to notify them of the need for assistance. Without a claim submittal, there may not be any way for the insurer to know that they are responsible for any payment on behalf of their insured and the healthcare facility will often expect the treated individual to make payment personally for their care.

Depending on the nature of the treatment required, claims may be made by the insured (or in some cases on their behalf) by the treatment center. In general, whenever possible, it is best to contact your insurer prior to receiving treatment to ensure that all payments will be made.

Insurance claims in Malaysia (by most providers) fall in to one of the following categories. Read on to learn more about them.

Types Of Malaysia Health Insurance Claims

Several types of claims are used by the many insurance providers in Malaysia and most companies will even use different kinds of claims depending on the type of plan selected. At times, even the same type of coverage will have multiple claim forms depending on the treatment required.

In-patient Treatment Guarantee General Claim – this claim is often filed in advance of a covered non-critical treatment that the insured is planning to undergo in the near future. These claims alert the insurer to their need to make payment for an upcoming treatment and in most cases, once the claim is filed, all subsequent communication can be handled by the insurance company with the treatment center, proving very convenient for the insured since all they will need to worry about is the planned treatment.

It is important to file this claim in advance, because it is not uncommon for an insured person to be denied treatment for a non-critical condition by the healthcare facility if they do not receive prior approval from the insurer with promise of payment.

In-patient Emergency Care Claim – unlike the In-patient Treatment Guarantee General Claim, this claim is not filed in advance as emergencies are never planned. Instead, the insured should focus on preserving and restoring their good health, and afterwards can contact their insurer to deal with payment or reimbursement for treatment received.

Because not all healthcare facilities will be in every insurers healthcare network, it is vital that an insured familiarizes themselves with their cooperating healthcare facilities that are available in their area so that in case of an emergency they can seek care there if possible.

Out-patient General Claim – this form is usually filed to request reimbursement for out of pocket payment that was made for necessary out-patient treatment. This may include doctor visits or emergency treatment that does not require hospitalization.

Out-patient Direct Settlement Claim – since most non-critical care will be administered through a network of healthcare facilities that can communicate directly with the insurer, this type of claim only requires the insured to present their information prior to care and then the healthcare facility will deal directly with the insurer for payment. The insurer will only need to make any co-payments that may be required of them.

Common Problems And Issues With Malaysia Health Insurance Claims

While insurance claims play an important role in making sure that all parties are promptly paid for needed treatments and coverage is always administered properly, the biggest complaint many have about their health insurance coverage is related to claims problems. As an insurance claim is a legal document, it is critical that claims are filled out, filed and handled properly. Read below to learn about some of most common issues concerning insurance claims.

Incomplete Paperwork Filing – probably the most common problem that slows the payment of treatment is due to paperwork not being completely filled out or important documents missing. It is important to make sure that all necessary signatures, payment receipts and any other necessary reference material are attached as proof of treatment and/or diagnosis, since claims are often denied due to lack of sufficient proof.

It is also advisable to make photocopies of all correspondence with your insurance provider and any other entity involving your claim, since documentation can be lost or misplaced at times and copies will serve as proof of your claim.

Pre-existing Condition Exclusion – in the case where a pre-existing condition is excluded from coverage but the insured seeks medical treatment for the condition, then the claim for reimbursement will be denied. When this happens, it can be very frustrating to the insured when they feel they are being denied coverage they deserve, so it is very important to make sure that you understand what is included in your coverage plan. To learn more about what is included, see Pre-existing Condition Health Insurance Coverage.

Contact Malaysia Health Insurance

Understanding all of the ins and outs of insurance coverage and the many claim types featured by the health insurance providers in Malaysia can be difficult. Malaysia Health Insurance can help you by giving you access to our vast database of healthcare and medical insurance information. To speak with an adviser right away click here, or complete the information request at the top of this page and adviser will contact you soon.