Cataract Real Insurance Claim Criteria and Preparation Strategies
The criteria for receiving cataract real insurance (Shilbi insurance) have definitely become stricter.
However, if you meet these criteria and provide sufficient supporting documentation,
even if payment is currently difficult, you may be able to receive payment later when Shilbi regulations are relaxed.
(However, this is limited to those who subscribed to Shilbi insurance before 2015.)
In the article below, I will explain the criteria for receiving cataract Shilbi insurance and how to prepare for it.
If you prefer watching a video, please refer to the well-organized content in the YouTube link below!
I am Kim Sun-young, the head director of Gangnam Healing Eye Clinic, with 17 years of experience as an ophthalmologist. ^^
I have performed over 20,000 cataract surgeries,
and I personally performed cataract surgery on my own parents. haha
Recently, I have been receiving casting requests from various programs such as KBS's <Make Me Man> and <Worthwhile Morning>.
Thanks to this, patients often call me 'the doctor that TV stations are looking for'... haha
(I'm just grateful.)
Many people are worried about whether they can receive cataract Shilbi insurance or not.
First of all, based on 2015, those who subscribed to Shilbi insurance after that cannot receive it.
Therefore, only those who subscribed before 2015 can receive Shilbi insurance,
and the following two conditions must also be met.
The above is from the press release of the Korea Life Insurance Association and the Korea Non-Life Insurance Association, and the notice of precautions for real loss insurance subscribers related to cataract surgery announced by Kyobo Life Insurance.
The most important part of the data is the content in the red box.
To summarize it well:
1. 6-Hour Hospitalization
You must prove that you were hospitalized for at least 6 hours.
Sometimes, ophthalmologists create and submit data stating '6 hours of hospitalization' even though they were not hospitalized.
Many of these cases are caught, and eventually, cataract Shilbi insurance is rejected.
The reason is that only 'hospital rooms licensed by the public health center', not 'general recovery rooms', are recognized as hospital rooms.
In fact, there are rare cases where many ophthalmology clinics disguise unlicensed recovery rooms and get caught.
The above photo is of the hospital room in my ophthalmology clinic.
We thoroughly observe the 6-hour hospitalization procedure here.
(There have never been any problems so far.)
2. Slit-Lamp Microscope Examination Paper
This is an important examination paper that can confirm the degree of cataract progression.
This is what a slit-lamp microscope examination looks like, and the above photo shows a patient with posterior capsule opacification.
It can be said that there are almost no cases where payment is not made due to this examination.
The reason is that if it does not meet the criteria, I do not recommend surgery.
In fact, in many ophthalmology clinics,
they lure patients with sweet words such as 'You can receive cataract Shilbi insurance' and perform surgery,
and then often do not take responsibility later.
In that case, the insurance company will give the answer:
'With this degree of cataract progression... it is not severe enough, so we cannot pay cataract Shilbi insurance.'
So, I send people with mild conditions back first,
and if they want surgery now or are okay with receiving Shilbi insurance later,
I proceed with surgery after sufficient consultation.
In this case, I directly help with everything from preparing insurance-related documents to submitting them.
I know that it is originally illegal for a doctor to help with this without an insurance agent license,
but I wanted to help patients receive Shilbi insurance, so I obtained an insurance planner license myself.
Also, I thoroughly educated our staff on insurance.
Cataract Shilbi Insurance
In a way,
these two conditions are essential and basic.
However, I hope that you do not go to an ophthalmology clinic that does not even follow these basics
and end up losing millions of won later.
If you read this article and want to receive a simple consultation,
I recommend reading at least 2-3 more blog posts rather than contacting us right away.
Just as applause comes from two hands meeting, not just one hand,
if you trust me more and visit,
I can do my best to provide a thorough consultation. ^^
The article below is written by me, so
I would appreciate it if you read it and make a reservation. ^_^
<Why Bother Coming to Gangnam for Cataract Surgery?>
<Reservation & Directions>
This post is written directly in compliance with Article 56, Paragraph 1 of the Medical Law for the purpose of providing medical information.
Source :https://blog.naver.com/wpsjtltmals7/223987281025
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