The global nature of international PMI means providers have to be on top of their game and get the claims process right first time, every time. Tim Mutton delves into the detail.
As always, when using third-party suppliers, the repatriation company must have a solid understanding of the provider’s claims processes and first-class communications systems to ensure the operation works perfectly from the customer’s perspective.
Culture is important too, and it’s not just the repatriation teams that need to have a strong understanding of differences around the world. IPMI providers should also offer an on-the-spot presence in the key expat locations to support expats with language difficulties, legislation and the healthcare nuances.
When something goes wrong, the last thing people want to deal with is a culture they don’t fully understand. And only local knowledge can take that uncertainty out of the equation.
The local office is the first port of call when a claim is made. It advises on critical issues such as what to do in an emergency and the extent of cover in place. After that, it provides the conduit for arranging treatment and maintaining communication with the hospital including ensuring the correct payment is made.
And the all-important follow-up with the patient after treatment guarantees that standards are maintained globally.
Educating customers
Finally, a word about clarity. Insurance providers have long been criticised for providing information that is full of jargon, long-winded and surrounded with small print designed to confuse customers instead of educate them.
Again, things are improving, with most providers tackling the issue, although some have been more successful than others.
It is essential that customers always know what they are covered for and that there are no nasty surprises when it comes to making a claim. This information should be easily available, both in print and online, preferably within a personal log-in area for each specific customer.
So in delivering the ‘promise’, providers are trying to innovate all the time. But there are obligations on the customer too.
This includes understanding their cover or clarifying when they need to. Key questions might include: What type of treatment needs a referral from a medical practitioner or hospital, and what doesn’t? The kind of treatments that need referral are rehabilitation and out-patient psychiatric care, for example.
Which in-patient or out-patient treatment requires prior authorisation? Usually no pre-authorisation is needed for out-patient care. When do they need to use an approved medical facility? Typically if they have a nil-excess policy and don’t want to incur any cost themselves.
When will they have to pay up front for services? This will normally be when the policyholder accesses out-patient care, either out of the network or when an excess is in place.
In other words, the better informed the customer, the more likely it is that the promise will be kept. Communications lie at the heart of all efficient claims outcomes. We all have a role to play and, fortunately, we live in an age when communicating is easier and faster than it has ever been. In our relationship with our clients, it is up to brokers and providers to ensure we are all speaking the same language.
Tim Mutton is business development director at Now Health International
