Understanding Why some medical bills are not reimbursed by Health Insurance companies.

Website Article For March Bills Are Not Reimbursed

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Educating Cambodians to avoid misconceptions. SafetyNet believes in transparency and explains.

1- What is a Health Insurance plan/ package?

A Health Insurance plan is ”a contract between an Insurance company and a Policyholder (insured member -or- group of members)” and, as in any contracts, it has detailed terms and conditions. The Insurance plan is protecting the Policyholder in case of unexpected medical expenses but not all medical bills are covered ! Mr Vatharo Huy, Chairman of The Insurance Association of Cambodia, emphasizes on the terms and conditions to avoid disputes between Cambodian insured members and Insurance companies.

2- Pay special attention to some jargons such as: ”Pre existing conditions”, ”Exclusions”, “Maximum”, “Limits” and ”Waiting period”  

”Pre existing conditions” are medical conditions that existed before the member enrolled in the Health Insurance plan, it is important to be transparent/ honest to your Insurance company. Otherwise, you have a risk to be denied payment when a bill arises…unless you have selected a Health Insurance plan that excludes your pre existing conditions (SafetyNet has the plan ”Family Health Protect” which excludes all pre existing conditions). 

”Exclusions”, “Maximum”, ”Limits” and ”Waiting period” are also important financial limitations to the Health Insurance plans. Make sure to read carefully the Benefits Table and Product Disclosure.

3- Abuse and Fraud to Insurance companies

Insurance companies do ask for several documents prior to reimbursement. This is to prevent abuse and fraud which are very frequent in the industry, not only in Phnom Penh but worldwide ! As long as you submit all the required documents and your claim inquiry is in line with your contract terms and conditions, you can be assured the Insurance company will carry out its duties. 

4- Insurance Industry in Cambodia is strictly controlled

The Insurance companies are regulated under the Ministry of Economy and Finance in Cambodia which is very strict. Nowadays, Cambodian people are safe to join Health Insurance plans and should not fear to be cheated by a licensed Insurance company. This point was highlighted by Dr Sovathana Hor, Deputy Director of Insurance and Pension Department, Ministry of Economic and Finance, in an interview with SafetyNet in December 2020.

 

SafetyNet Health Insurance Specialist has 97% Customer satisfaction rate (survey February 2021). 

The number #1 reason why members liked SafetyNet was: “Trustful Insurance”.