{"id":39097,"date":"2022-08-12T11:45:54","date_gmt":"2022-08-12T03:45:54","guid":{"rendered":"https:\/\/www.imoney.my\/articles\/?p=39097"},"modified":"2022-08-15T15:13:42","modified_gmt":"2022-08-15T07:13:42","slug":"medical-insurance-claim-guide","status":"publish","type":"post","link":"https:\/\/www.imoney.my\/articles\/medical-insurance-claim-guide","title":{"rendered":"How To Make A Medical Insurance Claim In 4 Steps"},"content":{"rendered":"<p>Need to make a medical insurance claim, or just curious about how it works? Here\u2019s what you need to know.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Why-do-I-need-to-make-a-medical-claim-Cant-I-just-use-my-medical-card\"><\/span><strong>Why do I need to make a medical claim? Can\u2019t I just use my medical card?<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>In an ideal world, we would just have to wave our medical cards to get medical attention, without having to fork out for hospital bills. Well, it does work that way\u2026in some scenarios.<\/p>\n<p>Some insurance policies are cashless policies, where you can present your medical card during admission to a panel hospital. The hospital will authenticate your details with the insurer, who will issue a Letter of Guarantee after confirming that you fulfil the policy\u2019s terms and conditions. This letter guarantees that your insurer will cover your hospital bills, allowing you to be admitted without having to pay the hospital bills yourself.<\/p>\n<p>However, this doesn\u2019t always happen. You may need to pay your hospital bill upfront if:<\/p>\n<ul>\n<li><strong>You don\u2019t have a cashless insurance policy. <\/strong>Some policies are reimbursement policies, which will require you to settle the hospital bills first before claiming for reimbursement later.<\/li>\n<li><strong>You were treated by a non-participating doctor or at a non-panel hospital. <\/strong>If your doctor or hospital is not covered by your policy, you will need to settle your hospital bills first and make a medical claim after you are discharged.<\/li>\n<li><strong>You were treated overseas. <\/strong>You may not be able to use your medical card overseas. However, depending on your policy\u2019s terms and conditions, you may be able to claim for reimbursement.<\/li>\n<li><strong>Your insurer did not issue a Letter of Guarantee. <\/strong>If, for whatever reason, your insurer does not issue a Letter of Guarantee, you can pay upfront and make a medical claim after you are discharged.<\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"What-should-you-do-before-you-get-treatment\"><\/span><strong>What should you do before you get treatment?<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Before you receive non-emergency treatment, contact your insurance provider or agent. That could clear up any confusion or disappointment that could arise if you try to claim for treatment that isn\u2019t covered by your policy.<\/p>\n<p>In addition, have your medical card ready so that your hospital can arrange for your Letter of Guarantee to be issued, if applicable.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"How-to-make-a-medical-claim\"><\/span><strong>How to make a medical claim<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Claim procedures will vary depending on your provider, but the process generally goes like this:<\/p>\n<h3>Step 1. Prepare the required documents<\/h3>\n<p>The required documents may vary depending on your insurance provider and policy, so it\u2019s best to check with them beforehand. You\u2019ll typically need to prepare the following documents:<\/p>\n<ul>\n<li>A photocopy of your NRIC\/passport<\/li>\n<li>Original hospital receipts and invoices<\/li>\n<li>Itemised hospital bills\/detailed bills<\/li>\n<li>Any diagnostic reports (blood test, coronary angiogram, X-ray, etc.)<\/li>\n<li>For overseas treatment: passport copies, boarding pass, flight ticket details, original itemised bill (and English translation, if necessary)<\/li>\n<\/ul>\n<h3>Step 2. Complete the required claim forms<\/h3>\n<p>To obtain the claim forms, contact your insurance provider or download a copy from your insurer\u2019s website. Depending on your policy, your doctor may need to fill in a Medical Examiner\u2019s Statement, which is a medical report that provides your insurer with more information about your diagnosis and treatment.<\/p>\n<h3>Step 3. Review and make copies<\/h3>\n<p>Check your documents to make sure that everything is in order. It\u2019s a good idea to make copies of them before submitting your claim. You may need to refer to them if there are complications with your claim.<\/p>\n<h3>Step 4: Submit your claim<\/h3>\n<p>Submit your claim to your agent or at your insurer\u2019s branch. Some insurance providers will also allow you to submit these online. And that\u2019s it! Although you\u2019ll need to be careful as you collect all the necessary documents and fill in the forms, the process is pretty straightforward.<\/p>\n<p>While you wait for your claim to be approved, you can check the status of your claim by contacting your agent, calling your insurer\u2019s customer service line, or sending an e-mail to your insurer.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"If-your-medical-insurance-claim-is-denied-can-you-appeal\"><\/span><strong>If your medical insurance claim is denied, can you appeal?<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Look through your policy terms again and review your submitted forms to see if everything is in order.<\/p>\n<p>If you feel that your claim has been wrongly denied, you can lodge a complaint with your insurance provider\u2019s complaint unit. And if that fails, you can seek help from <a href=\"http:\/\/www.piam.org.my\/consumer\/complaints-mediation\/\" target=\"_blank\" rel=\"nofollow noopener noreferrer\">PIAM Information Centre<\/a> (PIC) and <a href=\"http:\/\/www.ofs.org.my\/en\/who_can_lodge_a_dispute\" target=\"_blank\" rel=\"nofollow noopener noreferrer\">Ombudsman for Financial Services<\/a> (OFS). Consumers who hold an insurance policy with a provider that is a <a href=\"http:\/\/www.piam.org.my\/about-us\/member-companies\/\" target=\"_blank\" rel=\"nofollow noopener noreferrer\">member<\/a> of PIAM can get help from PIC and OFS to resolve disputes related to insurance matters.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Dont-delay\"><\/span><strong>Don\u2019t delay<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>We know that dealing with paperwork is a hassle, but you\u2019ll need to submit your claim within a time limit; usually within 30 days of treatment. If you miss this window, your claim may not be approved. A successful claim could mean the difference between being able to cover your treatment costs and being saddled with medical debt, so it\u2019s best not to delay.<\/p>\n<h6><em>This article was first published in July 2019 and has been updated for freshness, accuracy and comprehensiveness.<\/em><\/h6>\n<p><strong>Read More:<\/strong><br \/>\n<strong><a href=\"https:\/\/www.imoney.my\/articles\/public-holidays-malaysia\/travel-insurance-claim-malaysia\" target=\"_blank\" rel=\"noopener\">How To File Your Travel Insurance Claim In Malaysia<\/a><\/strong><br \/>\n<strong><a href=\"https:\/\/www.imoney.my\/articles\/making-a-car-insurance-claim\" target=\"_blank\" rel=\"noopener\">How To Make A Car Insurance Claim<\/a><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>It\u2019s not as complicated as you may think. <\/p>\n","protected":false},"author":43,"featured_media":53716,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[133,255],"tags":[363],"class_list":["post-39097","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-insurance","category-medical-insurance","tag-insurance"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Medical Insurance Claim Guide For Malaysians<\/title>\n<meta name=\"description\" content=\"Here\u2019s what you have to do before you seek treatment, how to file a medical claim for reimbursement, and what to do if your claim is denied.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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