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Why are 37% of medical insurance claims denied in Vietnam?

Why do your insurance claims get more denied in Vietnam Asia than in your country?

In this article, you will understand why Expat medical insurance claims are 37% more denied in Vietnam than in your country. Most relate to the Asian culture and healthcare management practices.

IIA Blog - 9 Feb - 3

Healthcare professionals and Health Insurers in Vietnam

Our consultant’s role is not to tell you ‘don’t worry’ with claims, it would not be realistic nor a reflection of our daily reality. Our role is to explain to you the benefits, to point you to possible problems, but more importantly to make sure the clinics and the insurers understand each other, when it comes to your insurance covered benefits.

A few things you should know about private Healthcare and medical insurance in Vietnam, they both have a few years of love-hate relationship precisely starting 2010 at a handful of  clinics for expatriates.

  • All is so new and so complicated for nurses, they need to learn insurance 
  • All is so new and complicated Vietnamese insurance claims staff to learn medicine
  • Clinics and doctors prefer cash upfront instead month end delayed payment
  • Vietnamese medical secretaries should learn wording for claims
  • Accounts and claims administrators should learn all insurers benefits and fine prints
  • In case of claims partial denial or rejected, the clinics bear the risk of unpaid consultation
  • Some of the costs are alien to them in terms of procedures and pricing
  • Some medical consultations if unpaid due to wrong decisions easily amount to 1-month salary. In doubt the insurer’s executive will ask you to pay first and claim later. The cashier at the clinic will ask for cash payment rather than honor the direct billing agreement between the clinic and the insurer. 

This is the reason our team needs to educate the Vietnamese in health insurance matters.

Here are some reasons for denials:

Insurance buyers don’t know their benefits and insurer wording

Most clients read the main benefits of their insurance plan but not the details of processing claims ending in:

  • Missing some documents necessary to claim like the proof of payment
  • Knock on wrong door: claim for a check-up (not included) instead of consultation
  • Missed the deadline (or so you think)
  • Especially in mixed couples whereby the Vietnamese wife and children have no briefing on health insurance claims
  • Missing medical proof of the illness is not pre-existing

Insurers wording and  Medical practitioners jargon are not the same

  • You are missing 1 of the elements: diagnosis, treatment prescribed, paid invoices
  • Missing Details on the invoice to matching your benefits limits
  • Doctor’s report looks like a pre-existing condition
  • Insurer’s staff misunderstanding of the medical diagnosis and exclude
  • Over charging: Partial denial for Items added that are not part of the treatment

Image Source: Internet

Misleading and abuses: leads to paranoid claims denials

One General Director of a prominent insurer in Vietnam, when asked how business is declared “I don’t understand how come, when Vietnamese purchase insurance they find a way to get ill and use their coverage?”.

The average GP consultation in Vietnam  international clinics reach an average of 150$ to 250$ when including medicines, tests, imaging. Which is more expensive than most European countries or Thailand.

Insurers willing to maintain affordable prices for insurance to stay competitive with the competitors work on razor thin margins, asking their staff to scrutinize claims. Some go to the extent of making claims executives responsible for claims acceptance mistakes -in deduction of their salary-. 

This results in delays and upfront denials at the slightest doubt. 

  • Insurance executives are recruited on their english speaking skills, as Health insurance business is so new.
  • The same goes for hospital recruits comes from ‘hospitality’ rather than medical
  • Over charging ‘deep pockets insurers’ with imaging up to the benefit’s limit. Why not stay 4 nights for the maternity as it is included in your insurance
  • Cross charging adding supplements and tests ‘just to know’

How professional advisors can help you get your medical claims paid in full?

Most insurers are ready to pay the claim in full if all pieces of the puzzle are submitted and if suspicious questions are answered in full. There may be some administrative issues when the claim is denied but not rejected.

Our job is to find the real reason for denial then:

  •  get the payment in full by appeal the claim with new elements
  • or explain what is or is not included in the clients insurance package.

Did you know that 17% claims are denied at first assessment, this ratio is 21% in Vietnam 1-out-of-5 for above reasons -mainly the uneducated medical executives in the healthcare insurance and claims processing-. Only 15% are re-assessed mostly because clients don’t know they are entitled to the full refund,  only if they have an insurance specialist broker to turn to. In most cases 67% to be precise, the claim is won after the appeal with the missing elements. Without the help of an insurance advisor, 18% of claims 1-of-5 money is left on the table of the insurers for minor administrative or mis-communication reasons.

For more information on Insurance Advisors Help

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insurance in Asia

Not only health insurance is different but most general insurance: accident, life, home, travel, office or even car insurance will be different than your past experiences.