Cataract Surgery Insurance Claim Requirements: What You Need to Know
It's true that the criteria for receiving cataract surgery insurance claims have become stricter.
However, if you carefully comply with these stringent standards and provide thorough documentation,
even if payment is initially denied, you may be eligible to receive full reimbursement later if the regulations are relaxed.
(However, this only applies to those who subscribed to indemnity insurance before 2015.)
In the following article, I will explain the criteria for receiving cataract surgery insurance claims and the measures you can take.
If you prefer watching a video, please refer to the well-organized content on the YouTube link below!
I am Kim Sun-young, a 16-year veteran ophthalmologist and the head director of Gangnam Healing Eye Clinic. ^_^
I have performed over 20,000 cataract surgeries,
and I even personally performed cataract surgery on my own parents...^^
Recently, I have been receiving inquiries from various programs such as KBS's Make Me Man and A Worthwhile Morning.
Perhaps because of this, patients often refer to me as 'the doctor sought after by public broadcasting'..ㅎㅎ (I am grateful.)
Many people are concerned about whether they will be able to receive cataract surgery insurance claims.
First of all, those who subscribed to indemnity insurance after 2015 are not eligible.
Therefore, only those who subscribed before 2015 can receive benefits,
but you must also meet the following two additional conditions.
The information above is from press releases by the Korea Life Insurance Association and the General Insurance Association of Korea, as well as Kyobo Life Insurance's guide to precautions for indemnity insurance subscribers regarding cataract surgery.
Among these materials, the most important part is the content within the red box.
Let's summarize this information!
1) 6-hour hospitalization
You need to prove that you were hospitalized for more than 6 hours.
Sometimes, ophthalmology clinics create and submit documents stating '6-hour hospitalization' even when hospitalization did not occur.
Submitting falsified documents can often lead to the denial of cataract surgery insurance claims at the last minute.
The reason for this is that only 'hospital rooms licensed by the public health center,' not 'general recovery rooms,' are recognized as hospital rooms.
In reality, many ophthalmology clinics disguise unlicensed recovery rooms, which can lead to issues, although it is rare.
The picture above is of the hospital room in my clinic.
We ensure that patients stay for 6 hours, adhering to the rules.
(There have never been any issues so far.)
2) Slit-lamp microscope examination report
This is a report that confirms the progression of cataracts.
This is what a slit-lamp microscope examination report looks like, and the picture above is of a patient with secondary cataracts.
Payment is rarely denied due to this.
The reason is that if the criteria are not met, I do not recommend surgery.
In fact, many ophthalmology clinics
deceive patients with sweet talk such as 'You can receive cataract surgery insurance claims,' and then abandon them later.
Then, the insurance company responds,
'Based on the progression of cataracts, it is not severe enough, so we cannot provide cataract surgery insurance claims.'
Therefore, I send back those whose condition is not severe,
and if they want to receive it now or are okay with receiving it later,
I proceed with surgery after sufficient consultation.
In this case,
I personally help with the preparation and submission of insurance documents.
I know that it is illegal for a doctor without an insurance license to help with this.
However, I wanted to help my patients receive indemnity insurance in any way possible,
so I even obtained an insurance planner license myself.
And I provided insurance education to all of my staff.
In a way,
these two things
are essential and basic.
However, I hope that you do not end up losing millions of won because you went to an ophthalmology clinic that does not even meet these basic requirements.
If you are reading this article and want to receive a simple consultation from me,
I would appreciate it if you could read at least 2-3 more blog posts before contacting me.
Just as applause requires two hands, not one,
if you trust me more and visit,
I will do my best to provide thorough consultation. ^^
The following is an article I wrote myself,
so please read it and make a reservation. ^_^
<Why go all the way 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/wpsjtltmals7/224006083589
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