Simple claim documentation

[TheOldBear]

This past November, I needed to visit the QM2 med center for an exam, and received some prescription meds - and a one page receipt for the service and meds.

When we returned home, I submitted the claim and provided an image of the receipt as that was the only available paperwork.

 

Claim processing was neither slow or speedy, and the only emails reported claim progress. The last email unsurprisingly said that the claim was approved, and the next business day was paid to the designated account.

 

A oddity was the paragraph in the last email reading:

While additional documentation would normally be requested to fully support your claim, on this occasion we have agreed to process your claim based on the information received.

 

What 'additional documentation' would normally be expected by a claims adjuster, or would be available from a ship's medical center?

[Babr]

I don’t know what details were provided on the receipt you received. Perhaps they would ordinarily want something with the diagnosis billing code and the attending physician’s certification / license number.

[GeezerCouple]

11 minutes ago, Babr said:

I don’t know what details were provided on the receipt you received. Perhaps they would ordinarily want something with the diagnosis billing code and the attending physician’s certification / license number.

 

I would guess something like this, too.

 

You (OP) wrote:

29 minutes ago, TheOldBear said:

This past November, I needed to visit the QM2 med center for an exam, and received some prescription meds - and a one page receipt for the service and meds.

When we returned home, I submitted the claim and provided an image of the receipt as that was the only available paperwork.

 

[emphasis added]

 

Our understanding from submitting claims to travel insurers is that they need a form completed and signed by the physician OR, if that's not available, at least a letter from the treating physician explaining the illness/injury.  One one occasion, that was simply a handwritten letter on letterhead, and a separate handwritten receipt (neither in English).  That was apparently fine.

This was not a large claim, so that probably helped.

 

All other occasions, we've had a physician fill out the travel insurer's own form.

GC

[klfrodo]

It could also be possible that a claim adjuster would want to know who your primary care provider is and would request a full and complete copy of your medical records looking for any history that could lead to a pre-existing condition.

Obviously, your case didn’t warrant such a review.

[TheOldBear]

The supplied form did not identify provider license numbers, just names and strings of "MBChB" and "MRCGP" near the provider names [MD and RN]

 

There is a CPT column but the values were just two dashes. ["Doctor New Consultation, Office Hours"; "Medication Dispensing"]

 

The ICD code J00 [common cold] was provided [and not on the form the PCR covid test was negative]

 

I spent 15 years writing medical office software - I don't know what else would be provided on a walk out statement. The med center wanted a medical history [updating their records] but no history info goes onto the statement.

[Philob]

On 1/12/2023 at 5:37 PM, TheOldBear said:

A oddity was the paragraph in the last email reading:

While additional documentation would normally be requested to fully support your claim, on this occasion we have agreed to process your claim based on the information received.

 

What 'additional documentation' would normally be expected by a claims adjuster, or would be available from a ship's medical center?

 

If your situation was more serious with a hefty bill, the adjuster would probably would want an itemized billing including what was diagnosed, treatment, and inventory of meds/supplies provided. 

[GeezerCouple]

2 hours ago, Philob said:

 

If your situation was more serious with a hefty bill, the adjuster would probably would want an itemized billing including what was diagnosed, treatment, and inventory of meds/supplies provided. 

 

This is the type of information that would be requested/required if the insurer insisted upon their own physician's portion of the claim form.

It's not the "medical history".  It's a description of the condition/symptoms/tests/treatments/etc., of the patient when treated.  Medical history *might* be relevant, but if not, it's unlikely to be mentioned.

 

If you are familiar with medical software, there's a chance that you have come across insurance claim forms for medical-based claims.  That's not exactly the same as what is entered into the patient history/records, although much of that current information might be included in the basic record if it's relevant, and if it exists.  A provider who has never seen the patient before won't have access to most of the history unless it's discussed, or unless there are scars or images from surgery seen on x-rays, etc.

(I found considerable discussion of my medical/surgical history observed from imaging when I went over the medical records I requested from a hospital stay overseas.  In this case, I had requested the entire set of medical records, which was *very* thick and much of it handwritten and not in English.  We just sent a scan of the *entire* thing along with my travel insurance claim forms.  [Note:  We kept a copy of the original.  Always!]  They could have had translations done or not.  The insurer would have helped with translation at the time of my care, but we had dear friends who lived in the country who came to the hospital and helped DH with some "patient advocacy".  In this case, our insurer probably had way *more* documentation than they wanted. 😉 )

 

I think it's especially important to be aware of this, although unfortunately, many first time "travelers in need of medical care, who have insurance" won't necessarily understand this.  We "got it" after the first time we needed to submit this type of information.  Fortunately, it was a local provider.  Had it been "some small clinic overseas", it might have been more difficult to track those records down later.  That's why we requested "all medical records please, for our insurance" in the situation described above.

 

Actually, now that I think about it, it wouldn't be a bad idea to keep a blank copy of that medical portion of the insurance claim form "in the cloud" so we could download it if needed.  I think we'll add that to our passport and Rx/etc., documentation that we already keep in the cloud.  Thus far, we always use the same travel insurer, so it's just that one form.

 

GC 

[Hlitner]

We have previously posted that one can never have too much documentation for a claim examiner.  Cruise ship medical centers are well aware of what is required from insurance companies and should provide sufficient documentation as a matter of course.  But, unfortunately, that is not always the case.  My advice (after a lifetime in medical insurance industry) is to always ask for a copy of the detailed medical record.  When we once did this on Princess, they told us we would need to pay for that documentation (I think it was about $25) which was charged to our onboard account.  The medical insurance company (GeoBlue) did reimburse us for that expense although not all insurance companies are that generous.  

 

Another hassle can be when travelers are treated in a foreign country and all the documentation is in a foreign language.   When DW was treated in a major Osaka hospital, all of her medical records and related documentation was in Kanji and kana.  Some insurance companies require the claimant. to get everything translated into English while others (such as Geoblue) will accept just about any language and do their own translations.  The cost of translation should be borne by the insurance company, but like many things in life who knows.

 

Hank