Health insurance claims, is it difficult to make health insurance claims, and the normal claims proc

If the past medical history is not truthfully disclosed, the insurance company will refuse to make a claim or increase the deductible on the grounds that the customer has not fulfilled the obligation to truthfully disclose the medical history. If the past medical history is directly related to the accident, the insurance company will directly refuse to pay.

For health insurance, illness insurance, life insurance, etc., which are very related to the personal health status of the policyholder, a medical examination report is required. This situation becomes an additional condition of the medical examination in the insurance company.

When making a claim, it must be a doctor's statement.

When your father is out of danger, you should get in touch with the insurance company in time.

Also, once the doctor has written a past history, it is useless for you to sue you.

Because insurance is the principle of truthful disclosure.

As long as it is written, it is like that, but the hospital can't lie to people, either the results of the examination, or they say it themselves, after all, they won't joke about their bodies because of that little compensation!

That case has 100% authority.

This is the problem with your family's words, of course, it would be great if the doctor could reissue the case!

I'm sorry I can't help you, I'm Taikang's internal staff, and I can only tell you so much about claims.

You should not tell your doctor about your physical condition in recent years. Because the hospital has an agreement with the insurance company. The insurance company can go to the hospital to check the patient's information.

But it doesn't matter if you've already said it. You can go to the insurance company. The law is always on the side of the vulnerable.

It's never hard to make an insurance claim. The difficulty is that you can't provide the claim materials required by the insurance company and still have to ask the insurance company to make a claim, or you don't buy the corresponding insurance but ask the insurance company to make a claim.

The first is like if you go to the bank to withdraw money, you don't have a bank card or no ID card, the bank counter can't handle it for you, this is a national regulation, and the bank can't withdraw money from you in violation of the regulations.

The second is like buying an electric appliance, you didn't buy a refrigerator, you only bought a TV, you have to use the TV as a refrigerator, you can't use it, you can't blame the TV for being fake!

Most people only hear that insurance claims are difficult, but they don't understand why it's hard to make claims.

In general, you will need to provide the following when making a claim

Insurance contract and proof of the most recent payment, claim application, beneficiary's ID card or heir's identity certificate and relationship certificate

The identity certificate of the insured, if the person entrusts another person, the "Power of Attorney for Claim" and the identity certificate of the client and the trustee and other basic information shall be issued.

When applying for a life insurance death claim, you must also provide: a medical death diagnosis certificate issued by a public medical institution at or above the county level designated or recognized by the company

Certificate of cancellation of household registration issued by the public security department

The forensic doctor's autopsy report and the cremation certificate issued by the funeral department (this point can be appropriately relaxed for rural areas that have not implemented cremation and funeral management).

Depending on the circumstances of the case, the insured party may be required to provide the original inpatient medical records (photocopy) or outpatient medical records.

When applying for short-term insurance death claim, it is necessary to provide: a diagnosis certificate issued by a public medical institution designated or recognized by the company, a certificate of cancellation of household registration issued by the public security and judicial departments, a post-mortem examination report or judgment, and a cremation certificate issued by the funeral department.

In case of death from disease, inpatient medical records (photocopy) or outpatient medical records must also be provided; In the case of accidental death, proof of accidental injury is also required: the traffic accident shall have the "Road Traffic Accident Liability Determination" issued by the traffic police department, the work-related death certificate issued by the labor department for the work-related death, and the case certificate issued by the public security criminal investigation department for criminal cases.

When applying for a medical expense insurance claim, you must provide: medical records issued by a medical institution designated or approved by the company.

Discharge summary, disease diagnosis certificate, original receipt of medical expenses (inpatients should provide a detailed settlement list of inpatients), and transfer certificate.

In the case of medical expenses due to accidental injury, it is also necessary to provide proof of the accident, such as the identification certificate of the industrial accident issued by the labor department, the road traffic accident liability determination certificate or criminal case certificate issued by the public security department, and the poisoning accident certificate issued by the health and epidemic prevention department.

When applying for a critical illness claim, you need to provide: the diagnosis certificate issued by the insured in a medical institution designated or recognized by the company, pathology report, electrocardiogram report, coronary angiography report, CT report and other examination reports related to the disease.

Before making a health insurance claim, it is necessary to understand what materials need to be provided when making a claim: 1. A copy of the insured's identity certificate; 2. A copy of the medical record is stamped with the hospital seal; 3. Original receipts for medical expenses and details of inpatient medical charges; 4. Original medical manuals, prescriptions, examination sheets, laboratory test sheets, etc.; 5. Discharge summary (provided and stamped by the hospital) How to purchase health insurance The basic insurance amount should be appropriate, which varies according to physical condition, family medical history, and the nature of work. The trick to purchasing health insurance properly is also to know how much medical care will cost if you have a current illness. The policy should be adjusted according to the actual situation.

Every three to five years, people should pay attention to opening their own insurance policy to check whether it is necessary to increase the sum insured, and make some appropriate adjustments according to changes in family members and financial situation. It is better to buy long-term insurance than to pay for annual insurance. Long-term health insurance is generally paid evenly every year at the rate corresponding to the year you start the insurance.

The younger the policyholder, the lower the premiums to be paid. It is better to pay the premium annually. Although there will be some ** discounts on the one-time payment, it is better to pay the premium of health insurance annually.

In fact, when you choose, don't blindly follow the trend, just choose according to your own economic conditions and actual needs. There are various health insurance products on the market, you can refer to the comparison, don't listen to the sales introduction, try to choose the most suitable product for yourself. Extended Resources:

The main types of insurance included in health insurance include medical insurance, that is, medical expense insurance, which refers to the insurance that takes the agreed medical expenses as the condition for paying the insurance money, that is, the insurance that provides medical expense protection, which is one of the main contents of health insurance, including not only the doctor's medical expenses and surgical expenses, but also the costs of hospitalization, nursing, hospital equipment, etc.; Sickness Insurance: Insurance that takes illness as a condition for the payment of insurance benefits, including general illness insurance and critical illness insurance. Usually, the insured amount of this kind of policy is relatively large, and the payment method is generally a lump sum payment of the insured amount immediately after the diagnosis of a special disease; Income protection insurance is an insurance that takes the interruption or reduction of income due to accidental injury or illness as the condition for the payment of insurance benefits, specifically refers to a form of insurance in which the insurer pays the insurance benefits in installments within a certain period of time when the insured is disabled due to illness or accidental injury, loses the ability to work and is unable to work, resulting in loss of income or reduction of income; Long-term care insurance Long-term care insurance is health insurance that compensates the cost of nursing care services for insured persons who require long-term care due to old age, illness, or disability. There are four levels of coverage: health care care, intermediate care, care care, and home care, but earlier long-term care insurance products did not include home care.

Before making a health insurance claim, it is necessary to understand what materials need to be provided when making a claim, and the information that needs to be provided includes the policy certificate; Claim form; Proof of identity of the person involved in the accident; Proof of beneficiary's identity and relationship with the insured; Medical record; Discharge summary; Original receipts for medical expenses, detailed statements of medical expenses (prescriptions); Copies of receipts for medical expenses; Disease diagnosis; Proof of accident; Forensic medical certificate or hospital appraisal certificate (disability appraisal report); Certificate of cancellation of household registration; A copy of the first page of the passbook (if bank transfer is selected).

Wow, you all know 5 conditions, not 4 or 6, but 5!

Insurance is good, as long as you buy the right insurance for yourself is the best protection.

Accidental health insurance covers death, disability, medical and work stoppage.

1. Death benefit: When the insured suffers death due to accidental injury, the insurer pays the death insurance benefit. The death benefit is a full payment.

2. Disability benefits: When the insured is disabled due to accidental injury, the insurer will pay disability insurance benefits according to the degree of disability. Disability benefits are paid in installments.

3. Medical benefits: When the insured suffers medical expenses due to accidental injury, the insurer shall pay according to the actual situation. There is a maximum limit for medical benefits, and the Italian out-of-group injury medical insurance is generally not covered separately, but as a rider for accidental injury death and disability.

4. Suspension of work payment: When the insured temporarily loses the ability to work due to accidental injury and is unable to work, the insurer shall pay the suspension insurance benefit.

Test your anti-risk index, experts will interpret it for you for free!

There are two types of critical illness, one is critical illness insurance, which is critical illness insurance with early payment.

You look at your own policy, which one it is. If it is the former, it is to wait until you are discharged from the hospital to lose money, but you also have to report the case when the doctor diagnoses it. The latter is to pay the sum insured immediately after reporting the crime.

Claim settlement is to accompany as much as the sum insured when buying insurance.

Extended reading: [Insurance] How to buy, which one is better, teach you to avoid these insurance"pits"

After all, the claim method of each health insurance product is not necessarily the same, and there will always be some differences, so how to make a claim for health insurance should be analyzed according to the specific situation.

If you have a little bit of insurance knowledge, you can take a look at this article by Senior Sister:

Ultra-complete! Everything you need to know about insurance is here

Next, the senior sister will introduce to you what things should be paid attention to when making health insurance claims! Don't talk nonsense, go straight to the dry goods!

Taking critical illness insurance as an example, we must first be clear about one thing, critical illness insurance does not pay corresponding compensation as long as the critical illness agreed in the contract is diagnosed, and some critical illnesses will only be paid by the insurance company if they reach a specific state.

Among the 28 types of critical illnesses stipulated by the China Banking and Insurance Regulatory Commission, only malignant tumors - severe, multiple limb loss, and severe burns will be diagnosed and compensated!

In addition, if the insured suffers from a critical illness that is not covered by the policy, the insurance company will not pay out even if it is diagnosed.

Therefore, you must carefully read the policy terms before you want to apply for a critical illness insurance claim!

The correct procedure for handling claims disputes

Secondly, after the insured is out of insurance, we can mainly report the case through the official customer service of the insurance company** claim**, the official website of the insurance company or the official WeChat of the insurance company*** and other channels.

The specific claim materials include the claim application, the insurance contract number, the legal and valid identity certificate of the insured, the legal valid identity certificate of the applicant and the relationship certificate, etc.

What are the general claim information? Details determine the success or failure of a claim! Hope.

There are many types of health insurance, and different types of insurance have different payment methods, so you can check the terms of the product to understand its specific payment methods. The following senior sister will take two very common health insurances - critical illness insurance and million medical insurance as examples to explain their payment methods.

Critical illness insurance is basically a payment insurance, after the insurance, if the insured is diagnosed with the disease agreed in the contract during the protection period, and meets the claim conditions, the insurance company will pay the corresponding insurance money in accordance with the contract, the use of this insurance money is not restricted, it can be used to pay medical expenses, can also be used as Gao Hong's follow-up expenses, family living expenses and so on.

In addition to protecting critical illnesses, many excellent critical illness insurance will also provide other protection, you may wish to find out what a good critical illness insurance looks like: a good critical illness Qi Zheng book insurance looks like this! You've been lied to for so many years.

Most of the million medical insurance is reimbursement insurance, during the protection period, if the insured is sick and hospitalized, how much of the reasonable medical expenses incurred meet the claim conditions of the million medical insurance, then the product will be reimbursed according to the agreed proportion.

It is necessary to note that the million medical insurance basically has a deductible, generally 10,000 yuan, which means that the insurer and the insured agree in advance that the loss is within the specified amount, and the insured bears the loss by himself, and the insurer is not responsible for the amount of compensation. If you want to buy million medical insurance, then about the deductible, it is recommended that you know more: what is the deductible?

Is the less deductible the better?

It can be seen from the payment method of critical illness insurance and million medical insurance that the functions of these two types of health insurance are very different and play in different places, so if the economic conditions allow, the senior sister suggests that it is best to configure these two types of insurance, so that the personal security system is more perfect, and the economic risk of disease can be transferred more effectively. Regarding the difference between critical illness insurance and million medical insurance, if you still want to know more, you can check this article again: after reading these contents of medical insurance, you will know why you should buy critical illness insurance.