TY - GEN
T1 - Analysis of Health Insurance Claim Decisions in Indonesia
AU - Asrori,
AU - Hikmah, Yulial
PY - 2020/4/3
Y1 - 2020/4/3
N2 - 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.
AB - 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.
KW - filing claims
KW - claims decision
KW - health insurance
U2 - 10.2991/assehr.k.200331.142
DO - 10.2991/assehr.k.200331.142
M3 - Conference contribution
VL - 426
T3 - Advances in Social Science, Education and Humanities Research
SP - 190
EP - 193
BT - Proceedings of The 3rd International Conference on Vocational Higher Education (ICVHE 2018)
PB - Atlantis Press
T2 - 3rd International Conference on Vocational Higher Education (ICVHE 2018)
Y2 - 2 August 2018 through 4 August 2018
ER -