Why it is Always Advisable to Avail Direct Billing Instead of Reimbursement

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In recent years, healthcare costs have skyrocketed in the UAE. It has led to a massive gap between medical charges and their affordability. Thus, an adequate insurance cover has become imperative for bridging this gap.

Because there is an increase in lifestyle diseases, health insurance is witnessing a gradual uptake among customers. However, many people are still not aware of availing benefits during a claim situation.  If you are familiar with the process and methods of filing health insurance claims, you can dodge the last-minute hassle.

When filing for health insurance claims, you get two types of claiming measures: direct billing based and reimbursement based. Look into these features of a health insurance plan because they directly impact your interests. Let’s take a look at whether you should go with direct billing or reimbursement.

  • Direct Billing

You can use a direct billing facility when medical treatment takes place in one of the network hospitals of your insurer. With this facility, you don’t have to splash out money from your pocket.

The insurance company settles the payment directly with the hospital, depending on the insurance policy terms and conditions and the sum insured you selected. You can avail the benefits of direct billing for both planned and unplanned medical treatments. For planned (elective) treatment, the Insurance company may require prior approval.

  • Reimbursement

Reimbursement is another process for setting a health insurance claim. In this facility, you bear the upfront cost first and later present the bill receipts to the insurer when filing a claim.

The insurance company evaluates the claim, and the agreeing reimbursement amount will be transferred to your account. This situation typically arises when you select a hospital as per your convenience, and the healthcare facility is not impaneled with the insurer.

Here are a few reasons why you should go with direct billing instead of reimbursement:

  1. Many people opt for direct billing over the reimbursement claim because of the convenience attached to it. Medical emergencies can take a toll on you and your family members. Direct billing eliminates the financial risk of having to pay a significant amount of bills that might disrupt your personal finance.
  2. Because the insurance company deals directly with the hospital, direct billing would take a lot of load off you and your family members.
  3. In reimbursement claims, it takes several weeks for health insurance companies to reimburse policyholders. Also, there is a possibility that the insurer may not reimburse the entire amount. It is especially true when you go outside of the medical network coverage.
  4. You can be sure of things that are not covered in your policy while availing of direct billing and take decisions accordingly, rather than getting surprised later on after reimbursement is processed.

Essential Things to Note:

The direct billing claim works if the treatment takes place in the network hospital of the insurance company.

Although direct billing is better than reimbursement in many ways, the reimbursement model is not flawed. It’s just hectic and time-consuming. You have to pay upfront and keep all the bill receipts and essential documents. And then apply for claim repayment, which can take a lot of time.

The Bottom Line

The choice between direct billing and reimbursement comes to convenience. Direct billing settlement scores over reimbursement claim settlement in this regard. That’s why many people advise availing of direct billing instead of reimbursement.

What Does a Basic Medical Insurance Cover by DHA Include?

Are You Covered Healthcare Insurance Protection Concept

The UAE has one of the best healthcare infrastructures in the world and is an attractive place for expats looking to move there. Today, health insurance is obligatory for Dubai nationals and residents. The UAE nationals are covered under government insurance programs. On the other hand, expats with a valid Dubai residency can avail of medical insurance services from registered insurance companies.

If you’re not a UAE national, you’ll require private medical cover. Your employer is legally required to provide you with basic medical insurance. However, it may not include your dependents. If you want to bring your family with you to Dubai, it’s better to take private health insurance.

Medical Coverage in Dubai:

  1. Basic Health Benefits

Medical Coverage

The Essential benefits plan covers the following subject to an annual limit of Dh 150,000 per insured member per year.

  • In-patient Treatment: It includes non-urgent (emergency and non-emergency) medical treatment, including tests, surgeries, and diagnosis-20% copay max cap of AED 500 per encounter.
  • Basic plan covers companion and parent accommodation (for children below the age of 16). The cost of accommodating individual accompanying an insured child up to the age of 16 years is max 100 AED per night.
  • Out-patient Treatment: This includes examination, diagnosis, and treatment routinely, with 20% paid by the insured
  • Lab tests, physiotherapy sessions (at most six per year), and radiology tests with 20% payable by the insured
  • Preventive medication or immunization procedures for newborn babies and children
  • Medicines – up to Dh 1,500 per individual, including 30% paid by insured per prescription.
  • Emergency health care and ambulance service during an emergency.
  1. Maternity Benefits
  • Three antenatal ultrasounds, antenatal blood tests, eight pre-delivery visits
  • The newborn is covered under the mother’s insurance scheme for 30-days from the date of birth – for screening, neo-natal tests, and other tests.
  • Initial investigations of anti-natal services include:
  1. FBC and platelets
  2. Blood group, Rhesus status and antibodies
  3. Venereal disease research laboratory test
  4. MSU and urinalysis
  5. Rubella serology
  6. FBS, random s or A1c
  7. HIV
  8. Hep C (if necessary)
  9. GTT (if necessary)
  10. 3 antenatal ultrasound scan

Visit to include reviews, checks and tests in accordance with DHA Antenatal Care Protocols.

  • 10% copay is applicable on all such services.
  1. Pre-existing or Chronic Conditions

Assert any pre-existing or chronic medical conditions at the time of the insurance application. The insurance company will provide comprehensive coverage for those conditions after a six-month waiting period. During the waiting stage, any emergency health care related to the disorders will be covered like any other claims under the program.

  1. Geographic Coverage Offered by the Plan

The basic healthcare services are covered within the Emirate of Dubai. On the other hand, Emergency medical treatment is covered within all emirates of the UAE. However, insurer can extend the geographic scope of coverage at their discretion.

Decide the type of geographic coverage you require. Make this decision based on visits that you make abroad. Some plans will only cover your city, while others will provide you the coverage in the entire UAE.

Some insurance companies offer international plans. Thus, these plans can cover you outside the UAE.

  1. Medical Network Coverage

An insured person can have direct access to provider’s available in network list suggest by insurer under basic plan. Generally, this network is limited and member can visit network hospitals for inpatient services and network clinics for outpatient services. The network coverage list differs from insurer to insurer. Thus, it’s essential to go through network list to know best providers.

Things Not Included in the Medical Insurance Policy:

There will be several things that won’t be included in your basic medical insurance plan. You must check the list to ensure that your claims are included in your policy. Also, check the exclusions so that you select a suitable option. Thus, in this way, you minimize the risk of getting your claims rejected.

The Bottom Line

In recent years, UAE witnessed several casualties due to a lack of health coverage. Thus, medical insurance became mandatory in Dubai and other Emirates.

You must do thorough research regarding health care coverage and seek insurance providers that will facilitate you in the longer run.

Common Mistakes Made While Filing a Medical Claim

Filing a medical claim and getting it approved is already very complicated. However, when your insurer rejects your medical claim at the time when you need financial aid for medical emergencies the most, may leave you helpless and even hopeless. In most cases, the reasons behind the disapproval of medical claims are the mistakes that policyholders make while filing medical claims.

At New Age Insurance Brokers, LLC, we have been assisting our clients with their selection of medical insurance and submission of medical claims in the UAE for more than a decade. Thus, we are in the best position to help you in this area.

Here is a rundown of the mistakes frequently made by medical policyholders when they file medical insurance claims. Keep them in mind while filing the current or next medical claim to increase your chances of medical claim approval.

  1. Incomplete Documents

Failure to provide complete documentation while filing a medical claim can instantly disapprove your medical claim. So, provide complete supporting documents when you submit a medical insurance claim. These documents may include but are not limited to bills with receipts, results of requested diagnostics, and correct and completed claim form with sign and stamp of hospital or clinic. When providing personal documents like a driver’s license, make sure that your documents are up to date.

  1. Late Submission

You must stick to deadlines as stipulated by your medical insurance provider while filing claims. The chances of insurance fraud are higher when a claim is submitted long after the hospital discharge. Sometimes, late claim submissions can also mean that the insurance provider has already offered the no-claim bonus for renewal. Thus, to avoid insurance fraud and confusion, insurance providers require their policyholders to adhere to stipulated claim submission deadlines. All insurers have a time limit for submitting reimbursement documents, and delay in submission will lead to denial of the claim.

  1. Incorrect/Incomplete Bank Details

Nowadays, insurance companies prefer direct bank transfers to the insured’s account. Any discrepancy in bank details, whether it is unintentional or intentional, can cause problems in getting your medical claim. So, make sure that proper beneficiary details are entered in the mobile app/website of your insurance provider.

  1. Incomplete Claim Form

Always ensure that you fill out all of the parts of your claim completely and correctly. Double-check your registered phone number, address, and other information before submitting your claim application. Submitting an incomplete or incorrect claim form can delay your claim approval process or even result in claim rejection. We understand that you might be mentally stressed at such times. So, take your time, get professional help, and fill out the medical claim form patiently.

Bonus Tip: It is recommended to avail direct billing instead of reimbursement as most insurers penalize by adding co-pay for going out of network.

Not being aware of the common mistakes made while claiming medical insurance can mean not being able to take advantage of the very medical insurance scheme for which you have been paying premium till now.

Thus, it is important that you complete the filing process of medical claims correctly. Avoiding mistakes during medical claim submission is the only way that you are most likely to be paid out quickly as much as possible for the financial loss you or your loved one has suffered.

If you need any help with medical claim submission or have any queries related to medical insurance, please feel free to contact us today.

Understanding the Exclusions of Your Medical Policy

Insurance Policy Agreement Terms Document Concept

Having medical coverage doesn’t mean that you will get coverage for all health and wellness issues. Before you invest in health insurance, you must understand that medical insurance covers illness and not wellness, unless it is specifically added to your policy. In the real world, no health insurance plan covers every medical condition regardless of how expensive the policy is.

Insurers in the UAE follow a common exclusion list regulated by Dubai Health Authority (DHA). These exclusions can be in the form of certain treatments, time-related restrictions, and various limitations.

This guide will help you understand the exclusions of a medical policy in detail.

Undeclared Pre-existing Conditions

Basic health insurance can cover pre-existing conditions. If a health plan does cover pre-existing conditions declared in the form, you will pay an increased amount of premium. However, any claim made for undeclared pre-existing conditions will not be covered.

Health Supplements

Supplements are often prescribed to replenish nutrients in your body. They don’t come under the purview of medicines essentially required to treat illnesses. Your insurance provider will not cover over-the-counter supplement purchases. However, if your doctor deems a health supplement to be necessary and prescribes it to you, then its cost might be covered by your insurer. One classic example is vitamin D which is covered only when deficiency is justified by your doctor.

Cosmetic Treatments

All kinds of cosmetic treatments and surgeries are regarded as exclusions in every medical insurance policy in the UAE. It includes facelift, deviated septum, implant surgeries, eyelid surgeries, and so on.

Dental and Optical Treatments

Basic health insurance plans generally exclude dental and optical treatments from their coverage. If you want these treatments to be covered, most insurers can cover them in exchange for an additional premium. However, some comprehensive health insurance plans may include them. Cataract surgery might be an exception as it comes under medically necessary treatment.

Alternative Treatment Practices

If you are someone who prefers alternative treatments, you must know that some alternative medicines and treatments are included in all health insurance policies. This includes Ayurveda and Homeopathy. Others such as Aromatherapy, Massage Therapy, Acupuncture, Hypnosis, etc. are exclusions. Besides that, chiropractic therapies are also excluded from most health insurance plans.

Treatments for Fertility Issues

Any fertility treatment for men and women is not covered under health insurance policies in the UAE. Hence, fertility prescription medications and in-vitro fertilization treatments are excluded as well.

Treatments for Weight Loss and Obesity

All kinds of treatments required for weight reduction are regarded as non-essential treatments in most cases. Thus, they also go under general exclusion from a medical policy.

Treatments for Certain Injuries

Most medical insurance policies don’t cover the expense of treatment for injuries caused by the following reasons:

  • Self-Harm, Conflicts, War, and Terrorism: No health insurance and even travel insurance will cover the cost of treatments that are received for injuries inflicted by self or caused by other reasons, such as acts of terrorism, war, and conflicts.
  • Natural Disasters: Injuries caused by natural disasters are also listed under the exclusion as ‘an act of God’.
  • Adventure and Professional Sports: Most medical policies exclude adventure sports and professional sports injuries; however, you can find some insurance policies designed specifically to cover such injuries.
  • Hazardous Activities: Injuries and illnesses sustained from hazardous activities, such as horseback riding and flying a plane, also fall under exclusions.
  • Accidents that involve illegal activity: Even though most health insurance plans cover almost all accidental injuries, they will not cover the expense if accidental injuries were caused due to involvement in illegal activity.
  • Military Training: The training for military training is extremely rigorous and can be even dangerous. Still, most health insurance plans do not cover any injury caused by military training.

Optional Medical Treatments

All health insurance providers offer coverage for expenses for only the treatments that are deemed absolutely essential by your doctor. Any non-essential and optional medical treatments fall out of the scope of your medical coverage. This applies even to the illnesses specifically mentioned and covered in the medical policy. Before a claim is approved, you are required to provide a medical record or statement from your doctor that declares that the treatment you are getting is indeed necessary and not optional. Otherwise, the medical claim will be denied for sure.

Apart from these, there are also other exclusions, such as growth hormone therapy, immunotherapy, contraception, prosthetics and other similar aids, and treatments and services received from healthcare providers outside of the network of your insurer.

After seeing this long list of exclusions, you might think that investing in health insurance is not worth it. On the contrary, there are still so many benefits of having a health insurance policy that will protect you from the rising healthcare costs in the UAE.

It is extremely important and even mandated by the UAE government for every resident to have at least a basic health insurance plan. Even if there are exclusions in every medical policy, you can still find a great health insurance plan with the help of a dedicated health insurance broker.

At New Age Insurance Brokers, we strive to help our clients choose the best health insurance plans for themselves and their families. Your financial security, happiness, and optimum health are our priorities. So, before you make the final decision, get in touch with us to find a health insurance plan that best serves your medical needs.

Steps to Take During an Emergency Medical Situation

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A medical emergency can take place anyplace and at any time. It is a circumstance that demands immediate action. The primary role of a person should be to focus on first aid and contacting emergency care at 998. Calling a healthcare professional will help you respond and treat any emergency. Remember, your action can save someone’s life.

A few noticeable conditions in an emergency medical condition include excessive bleeding, heart attack or stroke, burns, breathing problems, chest pain, seizures, shock, and head injury. When you see this happen, you should take the necessary actions.

Here are some steps to follow during an emergency medical situation:

  1. Recognize if Emergency Exists

You can confirm the emergency by checking for particular signs. The indicators are:

  • Dilated pupil
  • Slurred speech
  • Difficulty in breathing
  • Chest pain
  • Sleepiness
  • Unexplained confusion
  • Uncharacteristic skin color
  • Pale face
  • Unconsciousness
  • Sweating
  1. Taking an Action

In a medical emergency, time is a valuable thing. So, as soon as you recognize the signs, you should take immediate action. The action can involve:

  • Calling for medical assistance at 998
  • Offering comfort to the patient
  • Giving first aid to the victim
  • Any other service you can provide at the moment

You can help in a medication situation in several different ways. Sometimes people cannot recognize the medical emergency, while other times, they don’t care to act. But if you can help, you should take action because it can save someone’s life.

  1. Contacting Emergency Professional

Generally, people give comfort and confidence to the patient, which often helps them calm down. The next thing is to call an emergency expert because they can begin the treatment right away as they arrive.

  1. Care for the Patient Until Professionals Arrive

Avoid moving the patient from their place until they’re at risk. That’s because you may not be aware of where the injury is; so, it’s best to leave it for the professionals. The conditions that are life-threatening emergency are:

  • No breathing
  • No pulse
  • Severe bleeding
  • Unconsciousness

So, until the medical help comes, check for changes in the patient’s breathing level and whether they’re losing consciousness. Help the victim rest comfortably but without moving their body. Protect them from getting overheated or chilled.

Preparation for a Medical Emergency

  • Keep a First Aid Box

Prepare your first aid box that should contain scissors, roller bandage, antiseptic cream, pain killer, sterile cotton, and thermometer. Replace the item before its expiry. Also, keep the box in a safe and accessible place.

  • Save Crucial Contact on Speed Dial

Save all the vital contact you may need in case of emergency on your speed dial. These numbers can include the number of medical professionals, partners, neighbors, relatives, and friends.

  • Knowledge of the Medical Clinics Nearby

You must know the address and name of the hospitals near you.

It is essential to have medical insurance. Many people are unable to treat the condition because of no insurance coverage. Given the current expense of medical cost, it is best to get coverage.

  • Basic Training Against an Emergency Situation

Take some basic training to life support causes. Almost every hospital runs these. It can help save the life of many people.

The Bottom Line

Emergencies are often overwhelming and frightening. You may have a hard time deciding, so follow these steps during an emergency medical situation.