If you buy critical illness insurance, what should you pay attention to in the process of claim settlement?

The essence of this problem is how to claim for critical illness insurance. In my past 13 years' working experience, I can say that I have handled countless cases of critical illness insurance claims (I worked as the lobby manager of the customer service center and received numerous claims). Here, I will talk about my experience.

The claim settlement of critical illness insurance is a compensation process based on the terms of the insurance contract, the diagnosis report of critical illness and medical data. It not only involves the difference between clinical medicine and insurance medicine in the identification of critical illness, but also involves the internal critical illness insurance claims process of insurance companies. For customers, submitting a claim for serious illness is only the first step, and what is more important is the investigation, verification and follow-up accounting of insurance companies. Therefore, once you want to apply for serious illness claims, you should pay attention to the following points:

First, the identification of serious illness is based on the types and terms agreed in the contract, and the identification standards of insurance medicine and clinical medicine are inconsistent. So we need to do our homework before going to the doctor. For example, the identification of relevant hospitals; Insurance contracts will generally specify cooperative hospitals (places that do not meet the requirements will go to public hospitals at the latest), and private hospitals will basically not recognize them. In addition, some serious diseases require the implementation of prescribed surgical methods. If the hospital does not treat according to the operation method agreed in the contract, it may be refused compensation, even if the disease is cured. This also requires us to read the relevant clauses of the insurance contract carefully after taking out the insurance. Of course, you'd better consult your insurance service personnel before seeing a doctor. I believe you can get some reliable advice.

The second is to report the case when it is in danger. If you are diagnosed or hospitalized, you should call the insurance service personnel or report the case to the insurance company directly by telephone or online at the first time and provide hospitalization information. On the one hand, the insurance company system can start docking, and some insurance companies also provide on-site services; On the other hand, insurance companies can also be involved in the medical process in advance, which is conducive to improving the efficiency of claims.

The third is to pay attention to the waiting period of critical illness insurance. The waiting period of most critical illness insurance in the market is 180 days, and some are 90 days and 360 days. So first of all, it depends on how long the waiting period of the critical illness insurance you purchased is. If you are in the waiting period, you can't claim. In addition, there are some serious diseases, and it takes a certain period of time for the corresponding symptoms to be settled. This can be regarded as a waiting period for serious illness in a broad sense.

Fourth, pay attention to collecting complete claim information. Because most customers don't know how to identify a serious illness in the critical illness insurance clause, they need to provide complete corresponding information for medical treatment or examination. For example, at present, 70% to 80% of serious illness claims are concentrated in malignant tumors (cancer). Therefore, the most important basis for applying for compensation is the diagnosis report of a specialized hospital with corresponding qualifications, such as the pathological report of malignant tumor, including the analysis report of magnetic resonance imaging, CT, PetCT and other contrast films; Serious diseases such as cardiovascular and cerebrovascular diseases need relevant materials such as disease diagnosis certificate, discharge record and operation record. To put it simply, when you leave the hospital, you'd better keep the set of information that the hospital gave you. Although many insurance companies now support online claims application, many customers are still unfamiliar with the operation. In this way, in order to avoid running back and forth, you can take all the information to the customer service center or service outlet of the local insurance company for offline processing. Although it is likely that the staff will also help with online claims, after all, some guidance can avoid misunderstanding.

Fifth, what should I do if I refuse compensation? To be exact, the conclusion that general insurance companies refuse to pay compensation is prudent after all. However, it is not excluded that some cases are indeed controversial. What should I do if I receive the notice of rejection? First of all, look at what is written on the notice of refusal. The general refusal notice will explain the reasons for the refusal. If you have any objection to this and have factual basis to overturn its conclusion, first, you can appeal to the local claims department; Second, you can call the company's customer service hotline to make complaints; The third is to find the local regulatory authorities. Under normal circumstances, claims can be settled or negotiated. Of course, it does not include insurance fraud.

These are some of my personal experiences in handling serious illness claims: Before going to the hospital, it is best to consult your insurance service personnel, choose a designated hospital, keep all the inspection reports and medical materials, cooperate with the submission of claims, and don't panic if you refuse to pay compensation. It is your right to negotiate rationally and even complain.

1. Protection scope. You should make sure whether the critical illness insurance you buy includes the critical illness insurance you need to pay. If so, it's best. If not, you can't afford it!

2. Division of insurance liability. With critical illness insurance, you also need to know how to pay for each insurance, such as cancer and malignant tumor. As long as you are diagnosed, you can pay directly. Then there are chronic diseases of the elderly, reversible sudden serious diseases. Because this disease must have a certain treatment process, or a diagnosis process. These claims will be relatively slow.

3. The way and frequency of claims for specific mild diseases. Specific mild illness refers to life-threatening, but it belongs to the early stage of serious illness, and the relative treatment cost is low. What needs to be clear here is whether minor illness claims occupy the main insurance type and the number of claims!

4. Exemption from liability. In general, exemption means that the occurrence of such diseases is illegal or intentional, such as long-term heavy drinking, drug abuse and smoking. And this category is not bound by the claims. Please pay attention to this.

5. immunity. The insured has exemption, and minor illness has exemption. This is a way to reduce economic expenses for the insured or the insured. At present, most insurance products have mild illness exemption, but for the exemption of the insured, this should be added separately, whether it is reflected in the insurance contract.

6. The way of critical illness insurance works, you need to communicate with your insurance agent.

7. Pay attention to the commercial critical illness insurance contract. Whether all the terms in the policy are consistent with what your insurance agent said, the most important thing is the later settlement and service, so you must find a professional insurance agent. Then there is the hesitation period. We should make good use of this. If we feel that something doesn't work, we can directly refund it in full, and don't buy insurance in a muddle.

8. Be sure to attach hospitalization insurance. Serious illness and hospitalization complement each other, one can pay in advance and the other can be reimbursed later, and both are indispensable.

In fact, the matters needing attention are written in the contract, so it is good to learn and understand the contract.

1, coverage period of critical illness insurance.

If you buy lifelong critical illness insurance, you can do it at any time. If you buy regularly, you should pay attention to ensuring the time.

2. Coverage of major diseases.

All contracts for critical illness insurance clearly state the diseases covered. Many people get seriously ill and then go to the insurance company to claim compensation. The insurance company refused to pay compensation on the grounds that seriously ill patients were not covered, and consumers shouted injustice! Insurance is a liar! But in fact, there is no research to understand the content of protection. Therefore, it is necessary to buy what diseases for major diseases. At present, there are many risks of serious illness, which are divided into three types: light, medium and heavy. It is necessary to understand clearly.

3. Understand the exemption clause.

Similarly, it will be clearly written in the contract.

4. Understand the exemption clause.

Under what circumstances, the insurance company will not compensate.

5. Communicate with sales staff.

In fact, this is very important for our daily insurance purchase and claim settlement. Although some insurance salesmen are unprofessional, it is undeniable that some insurance salesmen are very professional. When you are seriously ill, if your salesman is very professional, you can contact him first, and he will tell you the specific follow-up claims process, including telling doctors how to write cases, which will play a great role in your follow-up claims.

Pay attention to the arrangement of medical records. If you don't tell your previous illness when you apply for insurance, don't reflect it in the case.