Making a claim that actually gets paid

A valid claim can still fail on paperwork.

Assembling it properly the first time is faster than arguing about it later.

Check the deadline first

• Find the claim deadline in the policy.
• It usually runs from the date of treatment.
• Diarise it immediately.
• Submit early, not at the limit.
• Late submission is refused regardless of merit.

Ask for the requirements in writing

• Insurers differ in what they need.
• Ask for the document checklist.
• Ask whether originals or copies are acceptable.
• Ask whether translation is required.
• Ask where and how to submit.
• Doing it right once saves weeks.

Ask the hospital for claim-ready paperwork

• Tell them at admission that you will be claiming.
• Ask for itemised invoices rather than a summary.
• Ask for a medical report at discharge.
• Ask for documents in an accepted language if possible.
• Obtaining these later is much harder.

Financial documents

• Itemised invoices, not summary totals.
• Invoices showing the provider's full details.
• Proof of payment separate from the invoice.
• Bank confirmation for international transfers.
• Receipts for medicines and equipment.
• Photograph everything before submitting.

Submitting from another country

• Ask whether scanned documents are accepted.
• Ask whether originals must follow by post.
• Keep originals until settlement is confirmed.
• Use tracked post if originals are required.
• Lost originals are difficult to replace.

Medical documents

• A report stating the diagnosis.
• A description of treatment given.
• Dates of admission and discharge.
• Relevant test results.
• Prescriptions matching the medicine receipts.
• Referral letters if the policy requires them.

Name and identity consistency

• Use one spelling across policy, passport and invoices.
• Ask the hospital to correct any misspelling immediately.
• Mismatched names are a frequent cause of delay.
• Check this at admission, not at claim time.

The claim form

• Complete every field.
• Use the name exactly as on the policy.
• Quote the policy and authorisation numbers.
• Have the treating clinician sign any section requiring it.
• Check dates for consistency across documents.
• Inconsistent dates trigger queries and delay.

Translation

• Confirm which documents must be translated.
• Ask whether certification is required.
• Use a translator with medical experience.
• Submit originals alongside translations.
• Keep copies of both.

Submitting

• Use the official channel only.
• Obtain written acknowledgement of receipt.
• Note the claim reference number.
• Ask the expected processing time.
• Keep a complete copy of everything sent.

Set your own reminders

• Diarise the expected decision date.
• Diarise any deadline they gave you.
• Diarise the policy claim deadline separately.
• Most lost claims are lost to time, not to dispute.

Tracking

• Follow up if the expected date passes.
• Prefer email so there is a record.
• Note names and dates of every contact.
• Ask for the specific reason for any delay.
• Polite persistence works better than frustration.

If they request more information

• Ask exactly what is needed and why.
• Ask for the request in writing.
• Supply it within any stated deadline.
• Keep copies of everything additional.
• Repeated requests for the same thing should be challenged politely.

If the claim is refused

• Ask for the decision and the clause relied on in writing.
• Read that clause in the full policy wording.
• Check whether the facts were understood correctly.
• Ask your doctor to clarify anything medical.
• Submit a written appeal within the stated period.
• Escalate to an ombudsman or regulator if available.

If the payment is lower than expected

• Request the calculation in detail.
• Check deductible and co-insurance applied correctly.
• Check no benefit limit was misapplied.
• Check the exchange rate used.
• Query specific lines rather than the total.

Currency and exchange rates

• Ask which currency the claim will be paid in.
• Ask which exchange rate and date are applied.
• Ask who bears any transfer charges.
• Provide bank details in the exact format required.
• Small errors here delay payment considerably.

Claims involving several providers

• Hospital, surgeon and anaesthetist may invoice separately.
• Laboratory and imaging may invoice separately again.
• Collect every invoice before submitting.
• List them on a cover sheet with totals.
• Ask the hospital whether more invoices will follow.

Keeping a claim log

• Record the date you submitted.
• Record every call with name and reference.
• Record what was promised and by when.
• Record each document requested and sent.
• This log is what wins appeals.

Common avoidable mistakes

• Missing the deadline.
• Submitting summary rather than itemised invoices.
• No proof of payment.
• No medical report.
• Missing pre-authorisation reference.
• Inconsistent dates or name spellings.

Partial settlements

• Some claims are paid in stages as invoices arrive.
• Track which invoices have been settled.
• Chase any that remain outstanding.
• Ask the hospital to confirm the balance is clear.
• Unpaid balances can be pursued years later.

If you are too unwell to manage it

• Ask a family member to handle it.
• Complete any authority form the insurer requires.
• Give them the full file.
• Break the task into small steps.
• Do not abandon it; deadlines are unforgiving.

Learning from each claim

• Note which documents were required.
• Ask for them at the point of treatment next time.
• Note how long settlement took.
• Adjust your expectations and cash planning accordingly.

After settlement

• Keep the decision letter and payment evidence.
• Keep the full claim file for several years.
• Note any new exclusion applied at renewal.
• Review whether the cover still suits you.

The point to remember

Three things:

1. Find and diarise the claim deadline immediately.
2. Submit itemised invoices plus separate proof of payment.
3. Refusals must be given in writing with the clause relied on.

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