How to claim a medical insurance? A complete guide to filling in a claim form
Many people today understand the importance of medical insurance and may even have more than one policy. However, not everyone is fully aware of the details of their plans.
What should you do when claiming insurance, and what points should you pay attention to? Claiming insurance requires what documents? We hope the following content helps everyone better understand this aspect.
Medical Insurance Claim Process
The claim process for medical insurance (including inpatient medical insurance, accident medical insurance, cancer medical insurance, group medical insurance, and other medical insurances that provide reimbursement on an actual expense basis) is generally not too complicated.
Taking Bowtie VHIS as an example, its claim process is very simple. All claim applications only need to be submitted online, and at the same time, a claims specialist will follow up on the case for the customer, assist in compensation estimation, and provide claim progress inquiries.
Before receiving treatment or check-up, obtain a compensation estimate to better budget for the medical expenses of the treatment or check-up.
- Download the Medical Expense Estimate Form and have it filled out by the doctor
- Log in to your Bowtie account to upload the estimate form
- The Bowtie claims team will follow up for you, usually with results within 4-6 working days.
The estimated amount depends on the information provided by the doctor. The estimate result is only a preliminary assessment and does not represent the final compensation amount.
After completing the treatment, remember to ask the medical staff to fill out and collect the following required original documents.
- Claim application form completed by the doctor
- Medical receipts
- Examination reports (if any), such as surgical reports, laboratory reports, CT scans, imaging reports
- Other supplementary documents, such as referral letter from the attending doctor, compensation estimate/statement from other insurance companies (if you have applied for compensation from other insurance companies)
You can apply for a claim online anytime, anywhere.
- Log in to your Bowtie account to apply for a claim
- Answer a few questions about this injury or illness
- Submit bank details
The time required for each case will vary depending on the complexity of the case, but we will follow up and process it as soon as possible.
As of March 2024, Bowtie’s overall average claim approval time is 4.4 working days. (Approval time may be affected by factors such as the complexity of the actual case, waiting time for medical reports or other supplementary documents)
Bowtie will notify you of the approval result via email. You can also log in to your Bowtie account at any time to check the claim progress.
After successful approval, the compensation amount will be transferred to your designated bank account within 3 working days.
Medical Expense Pre-approval Claim Process
Many insurance companies provide “cashless service / pre-approval” services for clients, allowing policyholders to avoid paying large medical bills upfront. Bowtie is no exception. Policyholders under Bowtie policies can use this service for treatment at all private hospitals in Hong Kong. The application and usage steps are as follows:
- Complete the pre-approval form and upload it to the Bowtie online platform at least 5 working days before admission/treatment, or have the hospital submit it on your behalf
- After approval, Bowtie will notify you of the result (success or failure and compensation amount) via email and SMS, and issue a “letter of guarantee” to the hospital
- Upon registration, simply inform the hospital that Bowtie has issued a “letter of guarantee” for the patient, and provide (1) identification documents and (2) admission/treatment date
- After treatment is completed, the hospital will directly submit the medical bills to Bowtie, and Bowtie will pay the approved medical expenses on your behalf
- If the medical expenses exceed the eligible compensation amount, you will need to pay the difference at the hospital upon discharge. Please keep the receipt, and you can apply for the shortfall claim on the Bowtie online platform
Documents Required for Claims
Medical Claim Application Form
Download Medical Claim Application Form
Applicable to policyholders who have undergone hospitalization or day surgery. Such forms can generally be downloaded from the insurance company’s website, and the form needs to be filled out and signed by the attending doctor.
If admitted to a private hospital, the hospital usually has claim forms from various insurance companies. As long as you clearly inform the attending doctor about your medical insurance, they have experience in filling them out. It is recommended to prepare a summary of your health insurance coverage for the doctor’s reference.
Original Medical Receipts
Original receipts issued by the hospital/clinic/medical institution, which must include the consultation and treatment dates, patient’s name, symptoms, diagnosis results, itemized charges, and be signed by registered doctors, registered physiotherapists, or other registered medical personnel.
Pathology Reports and Referral Letters
Including blood and other laboratory reports, X-rays, CT and MRI, etc. prescribed diagnostic imaging tests films/reports, referral letters issued by medical personnel, compensation estimates/compensation details from other insurance companies (if you have applied for compensation from other insurance companies), etc.
Insurance Claim Tips
- Ensure the claim application falls within the coverage scope and relevant terms of the policy
- Ensure the claim application does not involve exclusions (such as pre-existing conditions before insurance, non-medically necessary treatments or services, etc.)
- Ensure the claim application is submitted within the specified time frame set by the insurance company
- Ensure all submitted documents and receipts are complete
- Proactively communicate and follow up with the insurance company if necessary
- If the claim application is rejected or fails, request the insurance company to re-review the application
- If encountering unreasonable situations, seek assistance from the Insurance Authority or the Insurance Complaints Bureau
Bowtie VHIS Real Claim Cases
When you or your family members encounter health issues requiring doctor visits, treatments, or surgeries, most people inevitably worry about whether the medical expenses can be claimed, and fear dealing with complicated claim procedures and related supporting documents. This concern may be even greater for virtual insurance companies, worrying about insufficient compensation and lack of follow-up.
As a virtual insurance company, Bowtie deeply understands everyone’s concerns. We specially use several real compensation cases to present the “compensation rate” and “compensation amount” for different Voluntary Health Insurance Scheme plans:
Frequently Asked Questions
🤔 I need to undergo a minor surgery, and the doctor suggests doing it in an outpatient setting, but I only have hospitalization insurance. Can non-hospitalized surgeries be claimed under insurance ?
😎 The “surgeon’s fee” under the Voluntary Health Insurance Scheme covers the expenses for surgeries performed during hospitalization or in a day surgery center.
As long as the situation complies with the policy terms, even if the surgery is performed in an outpatient clinic or day surgery center , it will be covered.
🤔 I was hospitalized due to an emergency illness and only notified the insurance company after knowing everything was fine. I didn’t perform a compensation estimate. Can the medical expenses still be claimed?
😎 Actually, it’s not always necessary to file with the insurance company before hospitalization, but it’s best to understand the documents required for claims before admission .
This way, upon discharge, you can immediately check if the documents issued by the doctor/hospital are sufficient for claiming.
If anything is missing, you can ask the doctor/hospital for it right away.
🤔 I didn’t ask the doctor to fill out the claim form. Will I be unable to claim insurance?
😎 The insurance company’s claims department will review the claim based on the claim application form filled out by the doctor and the documents issued by the hospital.
If the submitted information is insufficient, the client may need to submit supplementary documents, or the insurance company may request documents from the doctor/hospital to obtain enough information to review the case.
🤔 After discharge, due to rest and follow-up visits, I delayed applying for the claim with the insurance company. Will the medical expenses be unclaimable?
😎 Each insurance company has different claim application deadlines, generally ranging from 30 to 90 days. The insurance company will handle claims submitted after the deadline based on the client’s different situations.
If there is a reasonable explanation, many insurance companies will handle it discretionarily.
🤔 During my overseas travel, I had an emergency illness and needed hospitalization locally. I didn’t buy travel insurance, only have VHIS. Can it be claimed?
😎 VHIS coverage is global *, so even if the insured is hospitalized overseas, it will be covered. However, when applying for a claim, note that upon discharge overseas, remember to request relevant medical documents from the doctor/hospital (e.g., claim application form filled by the doctor, original hospital receipts, test reports, etc.).
If the medical documents are incomplete, you may need to apply again from the local hospital after returning to Hong Kong, or it may take longer to collect all documents before submitting the claim.
* Psychiatric inpatient treatment is limited to hospitals in Hong Kong
🤔 The doctor recommends annual routine physical check-ups for me, and I have VHIS. Can the check-up fees be claimed?
😎 General routine physical check-ups are exclusions under the VHIS policy, so the check-up expenses need to be self-paid.
🤔 I lost the original receipt. Can I still claim?
😎 In general, you need to prepare the original receipt for the claim application. If the receipt is lost, you can request a certified true copy from the hospital or doctor, along with the reason for the lost receipt, and upload it to the Bowtie Online Platform for special review.
