1. What documents are required by the insurer to submit my claims?
If you are claiming for an outpatient treatment below are the required documents:
Claim form (diagnosis mentioned and form signed and stamped by the doctor)
All invoices related to your treatment
Proof of payment (credit card receipt copy or ‘cash paid’ stamp on the invoice if paid cash)
Pharmacy documents: all prescriptions and invoices
All lab tests results and reports mentioned on the invoice (e.g. ultrasound, X ray etc.)
If you are claiming for an inpatient treatment:
Same documents mentioned above for outpatient treament
Itemized breakdown of the final invoice
You can check the list of required document on the specific insurer claims guide (please select your insurer from the list).
2. How can I submit my claim online?
You can submit your own claim on both the Bayzat mobile app or on web as needed.
3. Can I submit a claim if my policy is not active yet?
If your policy is still not active or confirmed by the insurer, you will not be eligible to pay and claim a reimbursement for your treatment.
4. Can I submit a claim for my dependents (spouse, parents, children)?
Yes, you can submit your dependent’s claim online by selecting the dependent from the list while submitting the claim. You can do so online on the Bayzat app.
5. I am submitting claims on behalf of my employees, can I do that?
Yes as an Admin on Bayzat you can submit and manage claims for your employees online. Click here to learn how.
6. Can you confirm if my treatment will be reimbursed?
To confirm whether a treatment is covered on a reimbursement basis under your policy, check your policy benefits on the Bayzat app under Health Insurance.
Watch this video to learn how.
Alternatively, you can also request the table of benefits from your HR team for services that are covered under your insurance.
7. How long will it take for my claim to be processed?
You can find out more about your insurer claim processing time in your insurer claim's guide. Please select your insurer from the list of guides.
8. Why is my insurer asking for proof of payment/lab results/itemized invoice? Can I get my claim paid without it?
These are standard requirements that every insurer expects to verify what treatment occurred prior to reimbursing your claim. The insurer will not reimburse your claim if these documents are not provided.
9. Why was my claim rejected by the Insurer?
If you have submitted your claim on the Bayzat app, you can view your claim report by clicking on Medical Claims under Health Insurance to view your claim report in detail. Here are the steps:
Your claim may be rejected for any of the following reasons:
The treatment is not included in your policy benefits
You have exceeded the submission time for your requesting your claim
The treatment was related to a pre-existing condition not declared at policy when your policy was initiated.
Your claim is related to a DHA exclusion
Your plan is a basic plan (enhanced basic plan) that does not allow for reimbursement
10. The insurer was late sending my card and applied a co-pay/deductible on my claim. Can I get this reimbursed?
Yes you can, if the insurer delayed processing your medical card, the co-payment can be reimbursed. Please reach out to us on email@example.com and the team will liaise with the insurer for your reimbursement.
11. What is a referral letter and why is this needed for my physiotherapy reimbursement?
A referral letter is required from your GP or specialist doctor with a detailed description of your presenting symptoms and medical history. For physiotherapy claims, insurers require a referral letter to ensure that the treatment is medically necessary.
12. I am missing one of the required documents to submit my claim, can I still proceed for reimbursement?
All documents are required for a successful claim reimbursement. Please reach out to your medical facility and request for your missing documents. The insurer will not process your claim without it.
13. Why is there a delay in my claim reimbursement?
You can track the status of your claim on the Bayzat app, by clicking on Medical Claims under Health Insurance. Here are the steps:
Please verify your insurer processing time for claims on the specific insurer claims guide (please select your insurer from the list).
If the claim has exceeded the turnaround time, please email firstname.lastname@example.org with the case number requesting for an update on the claim.
14. What are the UCR rates applied on my claim reimbursement by the insurer?
The Network Tariff Rate (UCR) is a rate determined in advance by the insurer for each treatment type and used as a calculation basis for your claim reimbursement when you go out of your network of facilities.
15. I was not aware there is a time limit to submit claim documents. I have crossed the cut-off date, can I get a special approval from the insurer?
Sorry to hear that. Unfortunately insurers do not make exceptions. We strongly advise to read your insurer claims guide to ensure timely claim submission.
Please review your specific insurer claims guide (please select your insurer from the list).
16. How long does it take for the funds to be transferred to my bank account?
Please review your specific insurer claims guide for details on processing time (please select your insurer from the list).
17. What is the difference between going within my insurer network and outside the network?
Out of network means that the doctor or facility you went to does not have a contract with your health insurance company.
Within network means that your provider has negotiated a contracted rate with your health insurance company.
If you decide to go out of network for your treatment, the insurer will apply further deductions in terms of co-payment and UCR rates resulting in partial reimbursement only for your claim.
18. I am on an Enhanced Basic Plan (EBP), can I submit a claim for reimbursement?
For Basic Essential Plans (EBP), you will not be able to claim for reimbursement for treatments received outside of your network.