In today's world, if an emergency hospital visit occurs, even with health insurance, some cases may require patients to pay out of pocket first. Today, Thairath Money invites you to understand the "no upfront payment" benefit for health insurance holders to better manage life during unexpected events.
Many have sought treatment at public hospitals but faced the problem of "having to pay cash upfront." Afterwards, patients must request documents, treatment records, receipts, and medical certificates to submit claims to their insurance company. Being ill is stressful enough; having to advance emergency funds and handle paperwork for insurance claims adds to the burden.
However, several insurance companies are now expanding the "cashless claim" rights in public hospitals. The advantage is that patients do not need to pay cash for treatment; instead, hospitals directly submit claims and documents to the insurance company. Many may already be familiar with this system in private hospitals.
One system hospitals use is iClaim, a digital health insurance claim platform by Whiteploy Co., Ltd., which connects hospitals to insurance companies for treatment cost data and medical documents directly.
As health insurance buyers, it is important to know that "not every case" qualifies for Fax Claim (cashless payment) because it depends on the policy coverage and whether the hospital is linked with the insurance company you purchased from. Therefore, before using cashless services, always check with the hospital first. Insurance companies may exclude some cases from Fax Claim, for example, if the insured is still in the waiting period — typically 30 days for general illnesses or up to 120 days for severe diseases. The insurer has the right to verify if the claim fits the policy terms and may approve or deny Fax Claim rights.
This pain point led Muang Thai Life Assurance Public Company Limited (MTL) to design a simpler claim process.
Saran Lamsam, CEO of MTL, described the enhancement of outpatient (OPD) and inpatient (IPD) claim submission through cashless credit systems without upfront payment within coverage limits specified in the insurance policy. This allows customers to use their health insurance rights at public hospitals nationwide, in cooperation with iClaim, which connects with 400 public hospitals (including premium clinics within public hospitals).
"When illness occurs, the most important thing is timely access to appropriate care. We do not want expenses, claim procedures, or the need to prepare large sums in advance to become obstacles during a time when customers and their families are already worried about health," Saran said.
MTL’s network of contracted hospitals (MTL Smile Hospital Network) across Thailand is divided into three groups:
Previously, the company launched the MTL Claim Cover Check service, which allows checking and estimating treatment costs at contracted hospitals with the necessary departments and readiness. For example, if a patient needs surgery, they can use MTL Claim Cover Check to check the treatment cost and how much coverage their insurance provides, making it easier to plan expenses.
Finally, insurance is a contract with clear terms; buyers must carefully read and understand all exclusions beforehand to fully utilize benefits when ill.
SourceMTL
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