If you have been to the doctor and already laid out a chunk of change for treatment then the last thing you want is to wait well past your claim. For an international student it will be a Company who offers Overseas Student Health Cover (OSHC) or if you find yourself with Overseas Visitor Health Cover (OVHC) as a temporary visa holder, a delayed claim can leave you wondering what has gone wrong and when exactly are they going to pay out to you?
The good news is that a delay in claims does not necessarily mean that there is an issue of serious concern. Often, claims take longer because the insurer needs more information or documentation in order to assess your claim.
Most people think that as soon as a claim is filed, the insurer processes and accepts it right away. But most health insurance claims are subjected to several levels of scrutiny. Before a claim can be paid, the insurer must check policy details, validate treatment information and examine supporting documents to ensure that standards laid down in the policy have been met.
Insufficient documentation is one of the main reasons behind OSHC or OVHC claims being submitted slowly. Here is an, example of information that some members upload a receipt but do not know to add the invoice/treatment. If the insurer cannot confirm this service was provided, they may need to obtain more information. Until all such documents are received, the claim will often remain on hold.
Another common reason is incorrect personal information. A spelling mistake, a wrong membership number, old contact information or incorrect bank account information may lead to additional verification checks. However, all of this is for security and accuracy purposes, but they also result in longer processing time.
Sometimes the cause of the delay has nothing to do with the policyholder. As part of this process, health insurers may need to reach out to physicians, clinics, hospitals or health care providers directly to confirm treatment or confirm patient information. This is especially true with claims involving specialist services, larger amounts of the claim, and treatments that need further evaluation. This process protects against errors, but it can also create a lag time before the reimbursement is approved.
Insurer workload is another variable that has often been neglected. Processing times may be longer during peak periods, such as at university intake seasons or when many members are submitting claims. Even a correctly submitted claim could be delayed if the insurer is under a heavier-than-normal load of submissions.
The first thing people need to do if they haven been waiting longer then expected is check the status of their claim. Australia’s largest health insurances provide online member portals and mobile apps where you can track claims, access updates, upload a few more documents if needed, etc. Sometimes, the status of your claim can help clear up whether you are still under review or if something else is needed immediately.
In addition to this, it would also be beneficial to go through the documents that you have submitted. Ensure your receipts are clean and readable, invoices are present and all personal information corresponds to the information on your policy. Spend a few minutes double-checking these facts, and you might avoid trouble down the line.
The best thing you can usually do when there are no recent updates and the claim has been pending for a long time is to get in touch with customer service. Usually, a short call or email will reveal the cause of the hiccup and help the claim progress faster.
Most OSHC and OVHC claim delays are due to standard administration checks, not rejection of claims. Being proactive, responding quickly to requests for information and ensuring your documents are correct will vastly improve the process.
Final Thoughts
Delays in a health insurance claim can be uncomfortable, though more often than not they are easier to solve than an anxious person thinks. The key reason why this is: incomplete documents, additional verification requirements, the insurer’s workload and wrong information provided.
When you understand the claims process and check your claim status from time to time, you can prevent unnecessary delays and increase the possibility of receiving compensation faster.
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