The insurance process may sometimes appear complex and daunting, leading to misunderstandings or differing expectations. This article will serve to clarify Praram 9 hospital’s insurance payment process. We will look at the following:
Over the years, Praram 9 hospital has gradually expanded its affiliations with numerous insurance companies, both Thai and international. In the event whereby the hospital does not have a direct billing contract with your insurance company, you can pay and get reimbursed by the insurance company later.
With a huge number of insurance companies in existence, coupled with the many different insurance policies each of these companies have, we advise that it is best for you to clarify your personal coverage with your broker or insurance company directly. Most health insurance policies cover either inpatient or outpatient costs, with select policies covering both. We recommend that you always have your insurance card at hand, and give them a call or login into their membership portal to clarify your coverage.
Praram 9 hospital is a professional healthcare community and has a no fraud policy. Our hospital will not admit, investigate, or treat a patient unnecessarily without appropriate medical justification. In the event that the insurance company exercises their right to reject a claim, you will need to cover the costs.
Depending on your insurance company and policy, you are responsible for your reimbursement process. You might need to pay first and claim later. Praram 9 Hospital’s Utilization Resources team will be available to help you with your claim form and medical certificate. Together with your payment receipt, these documents should be submitted to the insurance company for reimbursement.
There are some situations where we can settle your bill via direct billing. This is when the payment is cashless and settled directly between our hospital and your insurance company. The hospital will submit your invoice and claim form directly to your insurance company, following your approval. If there are any billed items rejected by the insurance company, you will have to settle the bill for the corresponding amount.
You may come across a term called ‘deductibles’ used in your insurance policy. An insurance deductible is the amount of money you have to pay on an insurance claim first, before your insurance company pays the rest, according to your specific policy.
Co-payment refers to both the insured and the insurance company paying a specified amount. This is an insurance policy which shares the claim between both parties.
An insurance coverage limit is the maximum amount of money the insurance company will pay for coverage of a specific claim. This means that any expenses which exceed the limit has to be paid by the insured.
If you have pre-existing conditions which can be a chronic medical illness or injury, prior to starting your current insurance policy, these pre-existing conditions may be excluded from your policy. Furthermore, there are several categories of diseases which are usually rejected by insurance companies. These include psychiatric conditions (e.g. stress, depression, mania, schizophrenia etc.), pregnancy-related conditions (abortion, pre-eclampsia, labor), drug overdose or drug-related addiction, and suicide attempts. This is not an exhaustive list, and it is best to clarify your coverage with your insurance company or broker about what is included and excluded in your policy.
In some cases, pre-authorization (also known as prior authorization) by your insurance company will need to be obtained by the hospital, before you receive certain services. Some examples include obtaining Pre-Authorization before an elective surgery or procedure (endoscopy, coronary angiogram etc.), or chemotherapy. This usually happens when your insurance company requires your healthcare provider to obtain approval before it will cover the costs of treatment.
In the event of an emergency, pre-authorization is not required. Coverage for emergency medical costs will be subject to the terms according to your policy.
Having these items at hand will definitely make your hospital journey smoother, whether as an inpatient or outpatient.