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Insurance FAQ

01
What is the general procedure for direct billing and what are the required documents?
01
What is the general procedure for direct billing and what are the required documents?

Below is a general outline of our direct billing procedure and documents required by most insurers who have direct billing agreements with our hospital.

Please note that the direct billing procedure may differ between insurers, so we recommend that you contact your insurer regarding their specific requirements before engaging our services.

  1. Prior to engaging our services, patients should contact their insurer to verify their insurance coverage and responsibility AND request for a letter of guarantee/pre-authorization.
  2. Patients should present their medical card and letter of guarantee/pre-authorization to our hospital staff upon registration.
  3. Patients will be asked to fill in and sign the necessary documents, such as a medical claim form and medical voucher.    
  4. Patients may also be asked to present other documents, such as their passport or HKID copy.
  5. Patients must settle the amount deemed their responsibility after service, such as deductibles/copayments/fees for excluded items.      
  6. Our hospital will submit invoices and necessary documents to the insurer for claims adjudication and payment.      

*Please note: if the patient’s insurer requests for additional payments as part of the patient’s responsibility following a claim assessment, the hospital reserves the right to bill the patient for these outstanding payments.

02
How can I find out whether I am entitled to use the hospital’s cashless/direct billing services?
02
How can I find out whether I am entitled to use the hospital’s cashless/direct billing services?

Our hospital has direct billing agreements with most local and international insurers as well as third party administrators. We recommend that you check with your insurer regarding their direct billing arrangements with our hospital (if any) or contact our Patient Business Department before engaging our services.

Patient Business Department (Outpatient) - Tel: (852) 3651-8808; Email: regdesk@hkah.org.hk
Patient Business Department (Inpatient) - Tel: (852) 3651-8805; Email: hkahpsr@hkah.org.hk

03
My insurer does not have a direct billing agreement with your hospital, but I do not wish to pay out of pocket. What else can I do?
03
My insurer does not have a direct billing agreement with your hospital, but I do not wish to pay out of pocket. What else can I do?

Please check with your insurer to see whether they can appoint a TPA (third party administrator) that has a direct billing agreement with us and is able to issue a letter of guarantee (LOG) on behalf of the insurer. Alternatively, you can check with your insurer whether they are willing to place a deposit and/or settle the final bill on your behalf by credit card.

04
Your hospital is within my insurer’s network and has a cashless/direct billing agreement with my insurer. What is the procedure to enjoy cashless/direct billing services?
04
Your hospital is within my insurer’s network and has a cashless/direct billing agreement with my insurer. What is the procedure to enjoy cashless/direct billing services?

The procedure depends on your insurer’s guidelines. You may be required to present your medical card or request for a letter of guarantee from your insurer in advance. Please refer to FAQ 1 for an overview of the general procedure and required documents for direct billing. To find out the detailed procedure and documents required of your particular policy, please contact your insurer or our Patient Business Department:

Patient Business Department (Outpatient) - Tel: (852) 3651-8808; Email: regdesk@hkah.org.hk
Patient Business Department (Inpatient) - Tel: (852) 3651-8805; Email: hkahpsr@hkah.org.hk

05
If my insurer has a cashless/direct billing agreement with your hospital, does this mean I do not need to bear any costs for services rendered?
05
If my insurer has a cashless/direct billing agreement with your hospital, does this mean I do not need to bear any costs for services rendered?

This ultimately depends on your insurance/medical benefit policy. Some policies involve a maximum coverage allowance, copayments, deductibles, and/or exclusions. You are advised to clarify with your insurer before engaging our services.

06
May I still enjoy direct billing service if my insurer fails to issue a letter of guarantee (LOG) before I leave the hospital?
06
May I still enjoy direct billing service if my insurer fails to issue a letter of guarantee (LOG) before I leave the hospital?

To enjoy direct billing service, a letter of guarantee must be presented before you leave the hospital. Without this letter, you are required to settle any interim bill during your stay and/or final bill before you leave the hospital. In this case, an official receipt and statement will be provided to allow you to make a claim afterwards.

07
My insurance covers accommodation in a semi-private room. What should I do if I want to choose a private room instead?
07
My insurance covers accommodation in a semi-private room. What should I do if I want to choose a private room instead?

Please contact your insurer for clarification of your benefits. Some insurers may require patients to pay additional fees for this arrangement while others may withdraw their letter of guarantee and refuse to pay the final bill. You are therefore strongly advised to check with your insurer before choosing a room class that exceeds your benefit limit.

08
I do not want to pay out of pocket for my upcoming medical treatment. Are you able to check with my insurer to make sure everything is covered?
08
I do not want to pay out of pocket for my upcoming medical treatment. Are you able to check with my insurer to make sure everything is covered?

Upon a patient's request, we can check with his/her insurer to confirm whether they have a direct billing arrangement with us for the patient’s particular pre-planned medical treatment. However, confirmation of a direct billing arrangement does not necessarily indicate confirmation of coverage. The final reimbursement amount ultimately depends on the patient’s policy and its terms and conditions, validity, remaining allowance, and other factors at the time of service. Westrongly recommend patients to contact their insurer directly for details.

09
I am covered by two insurers for my upcoming medical treatment, both of which have direct billing agreements with your hospital. Can direct billing be arranged with both insurers in case one cannot cover the whole hospital bill?
09
I am covered by two insurers for my upcoming medical treatment, both of which have direct billing agreements with your hospital. Can direct billing be arranged with both insurers in case one cannot cover the whole hospital bill?

We will only arrange direct billing with ONE insurer, so please choose one at your discretion. If you are required to pay a portion of the bill, we will issue an official receipt for the portion you paid. You may then contact your second insurer to make a claim.

10
I am an obstetric patient and I have confirmed with my insurer that I can enjoy cashless/direct billing service at your hospital for my upcoming delivery. Do I still need to pay the deposit for my delivery booking?
10
I am an obstetric patient and I have confirmed with my insurer that I can enjoy cashless/direct billing service at your hospital for my upcoming delivery. Do I still need to pay the deposit for my delivery booking?

Yes. The deposit is for obstetric booking confirmation and bed reservation, so you will still be required to pay the obstetric deposit. If we receive and accept the letter of guarantee from your insurer during or before your hospitalization, we will refund the obstetric deposit to you after deduction of the patient's responsibility (e.g. deductibles/copayments/exclusions) according to the letter of guarantee upon discharge.

11
Why am I asked to present my medical card every time I visit your hospital? Shouldn’t it be on my record?
11
Why am I asked to present my medical card every time I visit your hospital? Shouldn’t it be on my record?

As per guidelines set out by insurers, we are required to ask for your medical card at every visit to ensure your eligibility is valid at the time of service, and so that we are able to provide direct billing services promptly and accurately.

12
I have already fully paid my deductible for this policy year. Why am I still being asked to pay the deductible for my treatment?
12
I have already fully paid my deductible for this policy year. Why am I still being asked to pay the deductible for my treatment?

The deductible paid during your recent visits may not be reflected in your insurer's claim system yet as they may still be processing. We calculate the direct billing amount based on the latest deductible information provided by your insurer. For details, please contact your insurer directly.

13
I enjoy direct billing services at other hospitals without having to pay any deductible or copayment. Why am I asked to pay at this hospital?
13
I enjoy direct billing services at other hospitals without having to pay any deductible or copayment. Why am I asked to pay at this hospital?

Collection of deductibles and copayments may vary between hospitals based on the terms and conditions of your policy, type of treatment you receive, and other factors. Your direct billing amount is calculated according to the guidelines provided by your insurer. For details, please contact your insurer directly.

14
If I have not been asked to pay anything upon leaving the hospital after using the direct billing service, does it mean my insurer will cover all the medical expenses?
14
If I have not been asked to pay anything upon leaving the hospital after using the direct billing service, does it mean my insurer will cover all the medical expenses?

No. We provide direct billing service based on our agreement with your insurer and according to guidelines provided by your insurer. The direct billing amount does not necessarily equal the covered amount. In some occasions, insurers may inform you of your responsible amount AFTER they finish the claims adjudication process. You are therefore strongly recommended to contact your insurer to clarify your coverage details before engaging our services.

15
I recently changed my name on my identity document but I had not informed my insurer of the change prior to receiving medical service. Will this affect the direct billing arrangement?
15
I recently changed my name on my identity document but I had not informed my insurer of the change prior to receiving medical service. Will this affect the direct billing arrangement?

Yes, it will. The patient name stated on the letter of guarantee and the medical card must match the patient’s name on his/her identity document. In the event that the names do not match, please ask your insurer to provide written confirmation (which indicates your identity document number) to prove that you are indeed the person indicated on the letter of guarantee and medical card.

16
May I still use the direct billing service if I have lost my medical card?
16
May I still use the direct billing service if I have lost my medical card?

Please contact and request your insurer to issue a letter of guarantee in advance. If we receive and accept a letter of guarantee before providing medical service, we are still able to offer direct billing service. You are also advised to apply for a new medical card at your earliest convenience

17
What do I do in case of emergency hospitalization or surgery?
17
What do I do in case of emergency hospitalization or surgery?

According to the direct billing agreements with insurers and third party administrators, in case of emergency, our hospital will assist to contact your insurance company for direct billing arrangement. Without a letter of guarantee (LOG), you are required to settle any interim bill during your stay and/or final bill before you leave the hospital. In this case, an official receipt and statement will be provided to allow you to make a claim afterwards.

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