Know the Meaning of Reimbursement and the Correct Way to Claim

Know the Meaning of Reimbursement and the Correct Way to Claim. Reimbursement is a term that seems familiar in the insurance world. Do you know what that means? Broadly speaking, reimbursement is indeed related to replacing funds that have been used previously. However, there are differences in terms of business operations and insurance. Check out more info along with good reimbursement procedures from below!

What is Reimbursement?

In terms used in company operations, reimbursement is reimbursement of costs used by employees for the purposes or interests of the company. Examples that usually use this system are business trips, accommodation, and so on.

Whereas in the insurance sector, reimbursement has almost the same meaning, namely disbursement, only the difference is that in this case, the disbursement is related to hospital costs that have been previously paid by the customer. The process doesn’t just end there, because then the customer needs to file a claim to get replacement money from the insurance company according to the nominal stated.

Tips for Applying for Reimbursement

The following is the procedure for submitting a reimbursement or claim on insurance, including:

1. Understand the Terms

The first point that must be known before submitting an insurance claim is to understand very well what the terms are. Why is that? Because one insurance company with another certainly has different rules and conditions, so we must understand very well with which insurance the cooperation is established. Several types of rules that apply are usually related to limits on the amount of replacement or replacement of certain transactions.

2. Keep Proof of Payment

Don’t forget to save proof of payment, because this will be the calculation of the claim submitted. Proof of payment, receipt, or receipt is a file or condition that must be completed when submitting a reimbursement.

3. Immediate Submission

It’s good, that you immediately submit a claim shortly after payment, because in general the insurance company will give a certain time limit for the reimbursement and if it is missed, then it will certainly be difficult and also detrimental to you. So, don’t wait, okay?

4. Make sure to return all data

Do not be too hasty or unfocused when applying for reimbursement to insurance, it is recommended to be careful and ensure that all data written or stored is correct and by the original. Because if you don’t, you will certainly experience obstacles and difficulties later.

Difference between Reimbursement and Cashless Claims

Know the Meaning of Reimbursement and the Correct Way to Claim
Know the Meaning of Reimbursement and the Correct Way to Claim

There are two ways to claim insurance, namely reimburse and cashless. In addition to the conditions discussed in the previous section, it is also important for us to know the difference between the two, namely:

1. Claim Reimbursement

In an insurance claim where at first or in the process we are required to pay our hospital bills first. Then, after finishing treatment or after being discharged from the hospital, we apply for reimbursement of funds according to the nominal that has been issued.

This method is indeed quite difficult, especially for those who do not have sufficient savings or even someone with a solid activity. Because the submission will take time and administrative requirements that must be met. However, there are also advantages to using this type of claim, namely that the premium costs are usually lower than cashless and generally, we are given the freedom to choose the hospital where we are treated.

Procedurally, the stage of submitting a reimbursement claim begins with taking treatment or receiving medical services at a hospital that has become a partner or partner of the insurance company. After that, you have to take care of the administration by selecting the type of reimbursement claim.

After taking treatment, complete administrative matters and make payments, then don’t forget to save every proof of payment. You must also complete the reimbursement document. Continue by sending the documents to the insurance company.

Then, if the claim has been received, the replacement cost is disbursed to the customer’s account. An example of a reimbursement that you can learn is a claim on Simas Jiwa insurance. You can see the complete procedure for submitting a claim at the following link.

2. Claim Cashless

Unlike the case with reimbursement claims, this method is simpler because insurance customers only need to show their membership card or insurance card, then the hospital will check regarding the health insurance covered and the active period of the insurance.

However, as previously mentioned, in this type of claim, customers generally cannot choose a hospital. In the sense that he can only

use the insurance facility in a place that has collaborated with the insurance company in advance. This means that there will be fewer choices compared to reimbursement claims.

The premiums paid are usually quite high. In addition, even though you have chosen insurance with a cashless system, there are several types of services at the hospital that must be borne by the customer first, then reimbursed, for example for surgery and so on.

Advantages and Disadvantages of Reimbursement and Cashless

To facilitate your consideration, consider the advantages and disadvantages of each type of claim below:

1. Reimbursement

The advantage is that there are more choices of hospitals or health services and lower premiums. While the drawback is that it can disrupt cash flow and the claim process takes a long time and process.

2. Cashless

The advantage of cashless is that it does not interfere with cash flow, because generally there is no need to pay for health services in advance. The claim process can be done immediately by showing the insurance card. The drawback is that you can only use the facilities at the hospitals that have cooperated and the premiums are generally more expensive

So, which type of claim insurance is the best?

The best is the type of insurance claim that suits your own needs. Make sure you fully understand how the cash flow and current conditions are. Either reimbursement or cashless basically can still help you in getting good health services and facilities.

Other Reimbursements

After being briefly discussed at the beginning, reimbursements are also widely used for work or business purposes. Reimbursement of business interests: ie business needs that use personal costs first, then they can be reimbursed for replacement.

Reimbursement of business trips: business trips out of town, including accommodation while there are often able to use personal funds first, then reimbursed to the company.

Cheating in Reimbursement

Several things that allow fraud in the reimbursement system include manipulation of claim fees more than they are, proof of falsified transactions, submissions for expenses that are not covered by insurance or the company, to submitting claims with a nominal greater or exceeding a predetermined limit.

This is information about reimbursements as well as disadvantages, advantages, terms, and procedures for submitting them. The most important thing is that we always ask for and keep evidence of any transactions and make claims honestly because if there are indications of fraud, our claims may be rejected and ultimately not get reimbursed.

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