“Help me! I am waiting to get out of hospital”
I receive a phone call along these lines on average about once a week, so I thought it would be useful to explain what should happen when you are admitted to hospital.
Along with your policy, you will receive a health insurance card. This should be given to the hospital as soon as possible. If you do not have your hospital card, your broker should have a copy and can send it to you. The hospital is then meant to contact the insurer with the diagnosis and treatment required so that the insurer can open a claim file and confirm coverage. Unfortunately, the hospitals do not always do this and say that they have contacted the insurer and they have been told, “get the patient to pay and claim it back later”.
If this happens, please contact the insurer’s customer service department or the broker that organized the policy for you. We have had multiple instances where the hospital has told the patient that the insurer has requested the patient pay and claim back from them. However, on phoning customer service [the phone number is on the back of the insurance card] we often find that the hospital has not even contacted the insurance company but was just trying to get the money up front.
Fast forward a few days and the doctor comes to see you. He says the operation was a success, you are recovering nicely and can go home.
What he fails to mention is that he may have another 20 patients to see, and then he goes and writes his notes. For those he is discharging that day he has to send instructions to the pharmacy who then send their bill to accounting and the doctor and his team do the same. Remember – there are many doctors replicating this process which takes, on average, about four hours.
All this, while you are understandably getting frustrated, but each time you ask a nurse what the hold-up is she answers that the hospital is waiting for a Guarantee of Payment [GOP] from the insurer.
Strictly, this is true as they must wait for the GOP. But what they may fail to mention is that the paperwork the insurance company needs to issue a GOP has not yet left the hospital. If you are waiting in hospital and want to know if the insurer has actually received the paperwork from the hospital, you can call the aforementioned customer service number.
Eventually the paperwork reaches the insurer. All the paperwork must be checked and for a small case the GOP will be sent in 30 minutes, larger cases take longer. Sometimes some paperwork is missing or needs further clarification from the doctor resulting in your departure being further delayed.
Bottom line, when the doctor smiles at you and says you can go home now, expect to wait another five hours at least.
For more information please go to our website www.macallanbroker.com or contact Macallan Insurance Broker at:
T. 038 427 904/5
E. info@macallanbroker.com
LINE. Macallan
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