{"id":2288,"date":"2019-12-10T10:50:49","date_gmt":"2019-12-10T02:50:49","guid":{"rendered":"https:\/\/www.pacificprime.hk\/blog\/?p=2288"},"modified":"2019-12-10T10:50:49","modified_gmt":"2019-12-10T02:50:49","slug":"important-things-hospitalization-claims","status":"publish","type":"post","link":"https:\/\/www.pacificprime.hk\/blog\/important-things-hospitalization-claims\/","title":{"rendered":"Most important things you need to know about hospitalization claims"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">While in most cases, your private health insurance allows you to receive inpatient treatments in the hospital without any hassle, there are still certain procedures, and documents patients should be aware of when being admitted to a hospital. To answer your <\/span><a href=\"https:\/\/www.pacificprime.hk\/health-insurance-plans\/in-patient\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">hospitalization insurance<\/span><\/a><span style=\"font-weight: 400;\"> questions, this article will relate to, and explain some key terms such as claim procedure, Guarantee of Payment letter, Pre-authorization letter, out-of-network hospital, and hospitalization claims refusals.\u00a0<\/span><\/p>\n<style type=\"text\/css\"><!--td {border: 1px solid #ccc;}br {mso-data-placement:same-cell;}--><\/style>\n<p><span data-sheets-value=\"{&quot;1&quot;:2,&quot;2&quot;:&quot;&quot;}\" data-sheets-userformat=\"{&quot;2&quot;:573,&quot;3&quot;:{&quot;1&quot;:0},&quot;5&quot;:{&quot;1&quot;:[{&quot;1&quot;:2,&quot;2&quot;:0,&quot;5&quot;:[null,2,0]},{&quot;1&quot;:0,&quot;2&quot;:0,&quot;3&quot;:3},{&quot;1&quot;:1,&quot;2&quot;:0,&quot;4&quot;:1}]},&quot;6&quot;:{&quot;1&quot;:[{&quot;1&quot;:2,&quot;2&quot;:0,&quot;5&quot;:[null,2,0]},{&quot;1&quot;:0,&quot;2&quot;:0,&quot;3&quot;:3},{&quot;1&quot;:1,&quot;2&quot;:0,&quot;4&quot;:1}]},&quot;7&quot;:{&quot;1&quot;:[{&quot;1&quot;:2,&quot;2&quot;:0,&quot;5&quot;:[null,2,0]},{&quot;1&quot;:0,&quot;2&quot;:0,&quot;3&quot;:3},{&quot;1&quot;:1,&quot;2&quot;:0,&quot;4&quot;:1}]},&quot;8&quot;:{&quot;1&quot;:[{&quot;1&quot;:2,&quot;2&quot;:0,&quot;5&quot;:[null,2,0]},{&quot;1&quot;:0,&quot;2&quot;:0,&quot;3&quot;:3},{&quot;1&quot;:1,&quot;2&quot;:0,&quot;4&quot;:1}]},&quot;12&quot;:0}\"><div class='code-block code-block-1' style='margin: 8px 0; clear: both;'>\n<p><a href=\"https:\/\/www.pacificprime.hk\/compare-quotes\/step-one\/?campSource=PPHK-Blog&utm_source=blog&utm_medium=content_banner&utm_campaign=Blog_Banner&utm_content=single\" target=\"_blank\" rel=\"noopener\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-1644\" src=\"https:\/\/i0.wp.com\/www.pacificprime.hk\/blog\/wp-content\/uploads\/2022\/12\/WP-Banner-revamp-final-20221207_1.-Single-final.jpg?resize=700%2C303&#038;ssl=1\" alt=\"Individual Health Insurance Plans\" width=\"700\" height=\"303\" data-recalc-dims=\"1\" \/><\/a><\/p><\/div>\n<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Hospitalization claims procedures\u00a0<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">For all of those who have <\/span><a href=\"https:\/\/www.pacificprime.hk\/health-insurance-plans\/in-patient\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">health insurance with hospital coverage<\/span><\/a><span style=\"font-weight: 400;\">, and receive their inpatient treatment in one of the so-called \u201cin-network\u201d hospitals of the insurer, the claiming process is very straightforward &#8211; because it\u2019s almost non-existent! If you underwent, or are planning to undergo treatment in a hospital that doesn\u2019t have a direct contract with your insurer &#8211; you can do it, however, the hospitalization claim process will take a bit longer, and will require a few more documents.\u00a0<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Basic hospitalization claims documents<\/span><\/h3>\n<ul>\n<li><span style=\"font-weight: 400;\">Hospitalization claims form;<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Original hospital receipts with a breakdown of charges;<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Medical reports* (some insurers require a detailed medical report with a diagnosis proof filled by the attending doctor);<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Identity card copy of the policyholder.<\/span><\/li>\n<\/ul>\n<h3><span style=\"font-weight: 400;\">Additional hospitalization claims documents<\/span><\/h3>\n<ul>\n<li><span style=\"font-weight: 400;\">Referral letters for any specialist consultation;<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Copy of police report\/traffic accident report (if involved in a traffic accident);<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Copies of diagnostic\/ laboratory tests reports or operating theatre summary*;<\/span><\/li>\n<li><span style=\"font-weight: 400;\">The Pre-authorization Letter, also called Treatment Guarantee; is a letter that acts as a confirmation from the insurer that they will cover the costs of the treatments (a guarantee that you get reimbursed). In case of insurers paying the hospital via a direct-billing agreement, such a letter is called the Guarantee of Payment letter (GOP).\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">*Please note that in Hong Kong, hospitals will charge a fee to give you a copy of your medical reports, for which you as a patient will have to pay yourself, as these costs are not included in health insurance policies.\u00a0<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">In-network hospitalization claims procedures<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">By an \u2018in-network hospital\u2019, we mean a hospital that has a direct-billing arrangement with your insurer. Direct-billing means that after your procedures are agreed by the insurer via a Guarantee of Payment or Pre-authorisation letter, you can get admitted to the hospital, and not need to pay for the insured treatments up to your policy limits. <\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><\/p>\n<ol>\n<li><b>Before hospital admission:<\/b><span style=\"font-weight: 400;\"><span style=\"font-weight: 400;\"> Consult a specialist in the hospital, your insurer, or a broker, and they will help you to obtain the Pre-authorisation Letter for your hospital stay.<\/span><\/span>&nbsp;<\/li>\n<li><b>During admission<\/b><span style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">: Show your insurer\u2019s medical card, approval documents (if any), and hospital admission letter. No hospital deposit is needed.<\/span><\/span>&nbsp;<\/li>\n<li><b>Before leaving the hospital<\/b><span style=\"font-weight: 400;\">: If your plan offers direct-billing, all you have to do is to sign a voucher without paying for the treatment in-front, and keep for your reference.<\/span><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">If your treatment costs exceed your policy limits, you will have to settle the outstanding costs out-of-pocket, or if you have another insurance plan that you wish to claim the remaining sum, you&#8217;ll get a Pre-authorisation Letter from them, and fill in a form, and send it for claims processing with all the necessary documents.\u00a0<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Out-of-network hospitalization claims procedures<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Sometimes, if the scheduled treatment is extremely expensive, insured person would opt to get their surgery\/ treatment in another facility that has cheaper rates, or go to a specialist hospital that is famous for their particular expertise in the particular medical field, even if the hospital is not directly in the network of the insurer. It is completely fine to do that, however, the hospitalization claims process might look a little bit different compared to the hospital in the insurer\u2019s network.\u00a0<\/span><\/p>\n<ol>\n<li><b>Before hospital admission: <\/b><span style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Contact your insurer or your broker to obtain the pre-authorization form. Ask your doctor to fill out the form, and return it to the insurer, so they can issue a Pre-authorisation Letter \/ Guarantee of Payment to you.<\/span><\/span>&nbsp;<\/li>\n<li><b>During admission<\/b><span style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">: Show your insurer\u2019s medical card, the approval documents, and the hospital admission letter. WIth the Pre-authorisation letter issued, usually, no hospital deposit is needed.<\/span><\/span>&nbsp;<\/li>\n<li><b>Before leaving the hospital<\/b><span style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">: Sign the claims form prepared by the hospital and pay the medical expenses.<\/span><\/span>&nbsp;<\/li>\n<li><b>After leaving the hospital<\/b><span style=\"font-weight: 400;\">: Submit claim form, and all other necessary documents within 90 days after discharge from hospital to your broker for handling, or directly to your insurance company. Depending on the insurer, you will get notified between 5 &#8211; 7 working days (or sometimes longer), about the result of your claim.\u00a0<\/span><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">These are the two most common scenarios when it comes to hospital admissions and claiming procedures for health insurance policyholders in Hong Kong. Plans with a direct-billing option are normally the preferred choice for many of Pacific Prime clients, as it shortens the claiming process without the patient needing to pay anything upfront.\u00a0<\/span><\/p>\n<style type=\"text\/css\"><!--td {border: 1px solid #ccc;}br {mso-data-placement:same-cell;}--><\/style>\n<p><span data-sheets-value=\"{&quot;1&quot;:2,&quot;2&quot;:&quot;&quot;}\" data-sheets-userformat=\"{&quot;2&quot;:573,&quot;3&quot;:{&quot;1&quot;:0},&quot;5&quot;:{&quot;1&quot;:[{&quot;1&quot;:2,&quot;2&quot;:0,&quot;5&quot;:[null,2,0]},{&quot;1&quot;:0,&quot;2&quot;:0,&quot;3&quot;:3},{&quot;1&quot;:1,&quot;2&quot;:0,&quot;4&quot;:1}]},&quot;6&quot;:{&quot;1&quot;:[{&quot;1&quot;:2,&quot;2&quot;:0,&quot;5&quot;:[null,2,0]},{&quot;1&quot;:0,&quot;2&quot;:0,&quot;3&quot;:3},{&quot;1&quot;:1,&quot;2&quot;:0,&quot;4&quot;:1}]},&quot;7&quot;:{&quot;1&quot;:[{&quot;1&quot;:2,&quot;2&quot;:0,&quot;5&quot;:[null,2,0]},{&quot;1&quot;:0,&quot;2&quot;:0,&quot;3&quot;:3},{&quot;1&quot;:1,&quot;2&quot;:0,&quot;4&quot;:1}]},&quot;8&quot;:{&quot;1&quot;:[{&quot;1&quot;:2,&quot;2&quot;:0,&quot;5&quot;:[null,2,0]},{&quot;1&quot;:0,&quot;2&quot;:0,&quot;3&quot;:3},{&quot;1&quot;:1,&quot;2&quot;:0,&quot;4&quot;:1}]},&quot;12&quot;:0}\"><div class='code-block code-block-3' style='margin: 8px 0; clear: both;'>\n<p><a href=\"https:\/\/www.pacificprime.hk\/compare-quotes\/step-one\/?campSource=PPHK-Blog&utm_source=blog&utm_medium=content_banner&utm_campaign=Blog_Banner&utm_content=family\" target=\"_blank\" rel=\"noopener\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1282 alignleft\" src=\"https:\/\/i0.wp.com\/www.pacificprime.hk\/blog\/wp-content\/uploads\/2022\/12\/WP-Banner-revamp-final-20221207_3.-Family-final.jpg?resize=700%2C303&#038;ssl=1\" alt=\"Family health insurance banner\" width=\"700\" height=\"303\" data-recalc-dims=\"1\" \/><\/a><\/p><\/div>\n<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Can insurers decline to issue Pre-authorization Letter\/Guarantee of Payment?\u00a0<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Yes, there are certain circumstances where insurance companies might not issue a Pre-authorisation letter \/ Guarantee of Payment letter to you. This is usually linked to various conditions, including policy terms and wording, and the type of treatment the patient is about to receive. Most typical reasons GOPs are being declined are:\u00a0<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">The procedure relates to an excluded condition (e.g. <\/span><a href=\"https:\/\/www.pacificprime.hk\/health-insurance-plans\/pre-existing\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">pre-existing condition<\/span><\/a><span style=\"font-weight: 400;\">, substance addiction, maternity treatment)<\/span><\/li>\n<li><span style=\"font-weight: 400;\">The claimable amount falls within the policy deductible<\/span><\/li>\n<li><span style=\"font-weight: 400;\">The procedure is deemed medically unnecessary (e.g. cosmetic surgery)<\/span><\/li>\n<li><span style=\"font-weight: 400;\">The policyholder has already reached their maximum annual benefits for the treatment in question<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">While clients with scheduled treatments can take their time ahead of the procedure and secure Pre-authorization letters, sometimes, where medical care is urgent and there\u2019s no time to waste, patients might then find themselves with their hospital claims being rejected by their insurance. What to do then?\u00a0<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">What if my hospital claim was rejected?\u00a0<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Most common reasons why insurance companies reject hospitalization claims are due to: <\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Incomplete or inaccurate insurance information<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Lack of prior pre-authorization<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Incomplete or inaccurate capture of medical records, including tests or procedures<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Diagnosis and procedure coding errors and omissions<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Insufficient medical necessity<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Co-pay or deductible amounts not reached<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">While the technical, or human errors, and lack of certain documents can be relatively-quickly solved, it will take a lot of effort, and time to do so. Fortunately, our services, besides finding and securing the best <\/span><a href=\"https:\/\/www.pacificprime.hk\/health-insurance-plans\/individual\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">health insurance plans for expats in Hong Kong<\/span><\/a><span style=\"font-weight: 400;\">, also include help with the claims submission\/claims handling for our clients. Our team&#8217;s help often leads to shortening the claims processing time, and by contacting the hospital\/insurer in your name, you can focus on getting back to health &#8211; not being worried about insurance administration procedures instead!\u00a0<\/span><\/p>\n<p><a href=\"http:\/\/www.pacificprime.hk\/contact-us\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">Contact us<\/span><\/a><span style=\"font-weight: 400;\"> today for impartial insurance advice, free quote and further information on how we can help with hospitalization claims in Hong Kong and beyond!\u00a0<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><\/p>\n<style type=\"text\/css\"><!--td {border: 1px solid #ccc;}br {mso-data-placement:same-cell;}--><\/style>\n<p><span data-sheets-value=\"{&quot;1&quot;:2,&quot;2&quot;:&quot;&quot;}\" data-sheets-userformat=\"{&quot;2&quot;:573,&quot;3&quot;:{&quot;1&quot;:0},&quot;5&quot;:{&quot;1&quot;:[{&quot;1&quot;:2,&quot;2&quot;:0,&quot;5&quot;:[null,2,0]},{&quot;1&quot;:0,&quot;2&quot;:0,&quot;3&quot;:3},{&quot;1&quot;:1,&quot;2&quot;:0,&quot;4&quot;:1}]},&quot;6&quot;:{&quot;1&quot;:[{&quot;1&quot;:2,&quot;2&quot;:0,&quot;5&quot;:[null,2,0]},{&quot;1&quot;:0,&quot;2&quot;:0,&quot;3&quot;:3},{&quot;1&quot;:1,&quot;2&quot;:0,&quot;4&quot;:1}]},&quot;7&quot;:{&quot;1&quot;:[{&quot;1&quot;:2,&quot;2&quot;:0,&quot;5&quot;:[null,2,0]},{&quot;1&quot;:0,&quot;2&quot;:0,&quot;3&quot;:3},{&quot;1&quot;:1,&quot;2&quot;:0,&quot;4&quot;:1}]},&quot;8&quot;:{&quot;1&quot;:[{&quot;1&quot;:2,&quot;2&quot;:0,&quot;5&quot;:[null,2,0]},{&quot;1&quot;:0,&quot;2&quot;:0,&quot;3&quot;:3},{&quot;1&quot;:1,&quot;2&quot;:0,&quot;4&quot;:1}]},&quot;12&quot;:0}\"><div class='code-block code-block-6' style='margin: 8px 0; clear: both;'>\n<p><a href=\"https:\/\/www.pacificprime.hk\/compare-quotes\/step-one\/?campSource=PPHK-Blog&utm_source=blog&utm_medium=cta_banner&utm_campaign=Blog_Banner&utm_content=quote\" target=\"_blank\" rel=\"noopener\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-1279\" src=\"https:\/\/i0.wp.com\/www.pacificprime.hk\/blog\/wp-content\/uploads\/2019\/06\/HK-BANNER-Couple.jpg?resize=700%2C303&#038;ssl=1\" alt=\"Get a quote banner\" width=\"700\" height=\"303\" data-recalc-dims=\"1\" \/><\/a><\/p><\/div>\n<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>While in most cases, your private health insurance allows you to receive inpatient treatments in the hospital without any hassle, there are still certain procedures, and documents patients should be aware of when being admitted to a hospital. To answer your hospitalization insurance questions, this article will relate to, and explain some key terms such &#8230;<\/p>\n","protected":false},"author":14,"featured_media":2289,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"Reimbursement for hospital stays can sometimes be confusing, but there are certain guidelines that are applicable to most international health insurance plans when it comes to hospital claims, and you can find them in this blog post!","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2},"_links_to":"","_links_to_target":""},"categories":[3,2],"tags":[793,792,1254,791,1257,758,1255,1256,956,680,36,398],"class_list":["post-2288","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-expat-insurance","category-insurance","tag-ban_fam","tag-ban_sin","tag-claims","tag-cta_gen","tag-denied-claims","tag-direct-billing","tag-hospital-claim","tag-hospitalization-claim","tag-inpatient-insurance","tag-insurance-claims","tag-pacific-prime","tag-private-health-insurance"],"jetpack_publicize_connections":[],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Most Important Things You Need To Know About Hospitalization Claims<\/title>\n<meta name=\"description\" content=\"Learn all about hospitalization claims procedures in Hong Kong in this short, yet infornative article from Pacific Prime Insurance Brokers!\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.pacificprime.hk\/blog\/important-things-hospitalization-claims\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Most Important Things You Need To Know About Hospitalization Claims\" \/>\n<meta property=\"og:description\" content=\"Learn all about hospitalization claims procedures in Hong Kong in this short, yet infornative article from Pacific Prime Insurance Brokers!\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.pacificprime.hk\/blog\/important-things-hospitalization-claims\/\" \/>\n<meta property=\"og:site_name\" content=\"Pacific Prime Hong Kong&#039;s Blog\" 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