How to claim your policy

How to claim your policy.

Review the policies or employee's booklet carefully to make sure that the plan contains the service in question. If there is reason to think that medical service is not covered, or if the company can not agree to understand the policy, first talk with the provider and the insurance company. By solving the questions first, you can prevent problems later.

You never think that your plan covers treatment or service. Please follow the rules of the plan such as pre-authentication requirements and use of network providers. Your health care provider may request you to pay insurance money at the time of consultation or to pay your joint insurance.

Please fill in the complaint form the provider or insurance company will give you. Be sure to include your policy number and other identifying information.

How to submit a complaint yourself:

• Check if your provider submits complaints for you or if you need to do it.
• If you need to do it, review the complaint information and make sure it is complete and accurate.
• Please submit a claim as soon as the claimant is billed by the provider.
• Please send it to the correct address.
• Keep a copy for your reference.
• Wait for the company's statement before paying directly to the provider.
• Please allow reasonable time for the company to handle your claim. If you need additional information to complete the bill, you need to notify the company. In some cases, additional information may be requested directly from the provider. Otherwise, we will send you a claim form to obtain detailed information.

If insurance company denies your claim:

• They should state the reasons for the benefits.
• If you do not agree with the reason for refusal, please check the company's appeal procedure with a policy or a booklet for employees.
• The company needs to answer questions about procedures concerning telephone appeal. Please call the company's aid line (the phone number is stated in the statement).
• Please submit appeal in writing. The company may need information from your doctor.