Hospital: Rongcheng Shidao Osteopathic Hospital.
Claim subject: Distal fracture of the left wrist**.
Total invoice amount: 1554342 yuan.
Social Security Reimbursement:$0
Commercial Insurance Reimbursement:11,500 yuan
The amount of this self-payment: 404342 yuan.
On August 2, 2023, the customer insured his mother with old age accident insurance and million medical insurance, with premiums of 88 yuan + 1393 yuan respectively.
On October 29, 2023, the client's mother accidentally fell at work, resulting in a fracture of the distal radius on the left side, and was hospitalized for a total of 10 days, with a cumulative cost of 15,54342 yuan.
Because it is a work-related injury, the medical insurance will not reimburse, and the accident insurance will also reduce the reimbursement ratio, according to 80% reimbursement, with a maximum reimbursement of 10,000 yuan within one year.
Medical expenses: 1554342 yuan (total cost) - 100 yuan (deductible) * 80% = 1235473 yuan, which exceeds the limit of 10,000 yuan in a year, so the medical expenses are reimbursed for 10,000 yuan.
Hospitalization allowance: an additional 50 yuan per day of hospitalization, 50 yuan * 10 days = 500 yuan.
Fracture and dislocation: the maximum compensation is 5,000 yuan, and the compensation is paid according to the proportion of different parts, 5,000 yuan * 20% = 1,000 yuan.
Total compensation: 10,000 + 500 + 1,000 = 115,000 yuan.
4043 remaining42 yuan was reimbursed by millions of medical insurance, but I was unlucky, and I was rejected as soon as I submitted it!
However, after many times of communication with the insurance company, the insurance company is willing to re-review!
I'll update it when the claim result comes out!
Customers should promptly notify your insurance broker after a claim event to understand the coverage they have purchased and the relevant precautions for going to the hospital.
Now the claim is very convenient, you can upload the claim information through the mobile phone, even if some large claims, we only need to prepare the paper materials, mail to the designated company address, and then wait patiently. The information required for the claim is as follows:
1.Diagnosis certificate and discharge certificate stamped by the hospital (issued by the attending doctor on the day of discharge, stamped at the settlement window).
2.Expense list, invoice, social security statement (handled at the settlement window).
3.Print the case one week after discharge from the hospital (paid printing in the hospital archives).
4.The front and back of the insured's ID card and the front and back of the bank card (for claim payment).
Accident Insurance: Big Armor No. 5 (Senior Edition) Accident Insurance.
Product Highlights: 0 deductible for accidental medical treatment, 90% reimbursement (including self-financed drugs).
Reimbursement of ambulance expenses.
Fracture and joint dislocation will be compensated extraordinarily.
Million Medical Insurance: Blue Medical Insurance (guaranteed 20-year renewal).
For product details, see the link: 2024 Million Medical Insurance Product Recommendation!
Accident insurance claim cases