Like any insurance, International Private Medical cover is littered with complicated and often misunderstood technical insurance terms. As a broker, it’s My Matchmaker’s job to help our customers understand the cover they are buying; and that often means explaining important terms. In this blog we discuss pre-authorisation and direct settlement – two terms that are worth getting to know.
Expatriates who claim on their International Private Medical Insurance will almost certainly come across the term ‘pre-authorisation‘. It’s also a term that appears many times in insurers’ communications when a policy is taken out, including within policy documents and membership cards. And it’s a high-profile term for a reason – it’s extremely important to make contact with your insurer before any in-patient or day-case treatment is received so that care can be pre-authorised. This allows your insurer to confirm the treatment needed is covered and that they will pay the associated medical bills.
Pre-authorisation also puts the insurer directly in touch with the hospital or clinic where the treatment will take place so that they can look after all the administrative details and keep an eye on treatment plans. This is one less thing for the expat to worry about, leaving them to concentrate on getting better.
When contact is made with the insurer for pre-authorisation, having the membership card and number ready helps to speed up the process. The insurer will also ask a number of questions such as:
• What condition are you suffering from?
• When did your symptoms first begin?
• When did you first seek medical advice and from whom?
• Has any treatment been recommended to date?
• Have you already received treatment?
• What is the name of your doctor or consultant?
• Where will your proposed treatment take place?
• Will you need to stay in hospital and for how long?
Treatment will not be pre-authorised if it’s not covered on your policy. If you are unsure about this, make sure you speak to your broker or insurer directly.
Direct Settlement occurs when the insurer settles their member’s medical bill directly with the medical facility that has administered the treatment. This makes the patient’s life easier and less stressful at what can often be a difficult time. Insurers’ usually only offer this facility when a hospital or clinic within their recommended network is used. Where a network hospital isn’t available, the insurer may still be able to settle bills directly if the treatment is pre-authorised – so it’s always worth checking before seeking treatment.
When a treatment centre outside of a network is used, the patient will need to pay the medical facility themselves and claim the costs back from the insurer. Medical bills, particularly for some in-patient treatment, can be extremely expensive so this is not advised.
Insurers aim to make paying for medical treatment as easy as possible. After all, when their members are unwell, the last thing the insurer wants is for their clients to worry about completing lengthy forms and arranging bill payments. For both insurers and customers, paying for pre-authorised claims directly with hospitals, clinics and other providers can save time, money, inconvenience and stress.
Pre-authorisation and direct settlement often come hand in hand and are two important aspects of International Private Medical Insurance to understand. Not making the proper checks can leave a hefty bill that will need to be paid and claimed back or, worse still, a bill that the insurer may dispute.