Analysis of Health Insurance Claim Decisions in Indonesia

Research output: Chapter in Book/Report/Conference proceedingConference contributionpeer-review


This research explains the process of filing a claim, as well as one Indonesian health insurance company’s decision-making process regarding medical claims. The research is descriptive and qualitative, and the data was collected using observations, interviews, and relevant company documents. In the claim submission process, a claim form must be filled out and accompanied by all the required documents. Claims are approved, rejected, or postponed (a pending claim). The decision process for claims includes completing the necessary documents and verifying that the data submitted is accurate. Incomplete documents can cause claim settlements to be postponed. If the customer does not complete the requested documents within 30 days, the claim will be rejected. If submitted information is not valid, if fraud or abuse is indicated, or if a claim includes a policy exclusion, its submission will require further investigation, and a decision about the claim will be postponed. Investigations can be done by contacting the customer, a claim forum, the hospital, or other related parties.
Original languageEnglish
Title of host publicationProceedings of The 3rd International Conference on Vocational Higher Education (ICVHE 2018)
PublisherAtlantis Press
Number of pages4
ISBN (Electronic)978-94-6252-947-2
Publication statusPublished - 3 Apr 2020
Event3rd International Conference on Vocational Higher Education (ICVHE 2018): “Understanding Digital World. From Theory to Practices.” - Batam, Indonesia
Duration: 2 Aug 20184 Aug 2018

Publication series

NameAdvances in Social Science, Education and Humanities Research
PublisherAtlantis Press
ISSN (Electronic)2352-5398


Conference3rd International Conference on Vocational Higher Education (ICVHE 2018)


  • filing claims
  • claims decision
  • health insurance


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