Medical Insurance: the procedure required for claims in case of medical expenses
This brief article is meant to describe the correct procedure you need to go through in order to properly claim your medical expenses when you have medical insurance. It must be noted that the procedure differs depending on the kind of expenses (inpatient, outpatient), as well as the kind of insurance company you have a contract with (Cypriot or international). In either case, you are free to select the doctor and clinic of your liking in Cyprus or abroad. Make sure you pay attention to your contract, since it may specify a particular geographical region where expenses are allowed, while for countries like the USA there may be different coverage limits.
The reader must note that the process described below is different than the one required for immigration insurance claims.
Cypriot Insurance Companies
Inpatient expenses
In case of a severe illness or an accident requiring unexpected hospitalization, you or a family member will need to show the clinic your medical card (a small card the size of a credit card with your name and the contract number on it. The card will be given to you as soon as your contract has been issued).
In case of scheduled surgery or hospitalization, please inform us of your intention as soon as possible (at least five days ahead) on the email: [email protected] and on the phone number +357 26 600620.
If there are inpatient expenses, those are directly paid to the clinic by your insurance company, minus the excess amount if that is applicable. The excess is the amount paid by the insured person directly to the clinic and is deducted from the entire amount the insurance company will pay.
For example, if your contract provides an excess of 200 Euro and you have had surgery costing 6,500, your insurance company will pay for 6,300 and you will cover the remaining 200 euro. Contact your insurance agent to find out the deductible amount of your contract, which you have the right to change by adjusting the insurance premium.
Outpatient expenses
In order to file a claim for outpatient expenses, you will need to initially cover the costs of the clinic and medicine yourself. You will subsequently have to gather any kind of written proof you can provide (e.g. medical prescriptions, invoices, payment receipts, test results, etc.) and bring them to our office.
You will then be given a form that you will have to fill in, either in English or Greek. On this form you will describe your symptoms and illness history. After that, you will be given another form that your doctor will need to fill in during your next visit.
All of that will need to be filled out and submitted in less than 60 days. In case you cannot visit us at our office, you can send all your documents to the following address:
1 Nikou Kazantzaki Street, 3rd Floor, Paphos, 8035.
Mobile number: 99 656564, Phone number: 26 600620
Your application will be examined by the medical council of our insurance company and a decision will be made within a month.
There is a possibility you will be asked to provide additional documents during your application consideration.
If your application is approved, a cheque will be issued under the name of the insured person or there will be a bank transfer in his/her account.
It has to be noted that only the insured person has the right to collect that money.
International Insurance Companies (MetLife, ALC Health)
Inpatient Expenses
In case of a severe illness or an accident requiring unexpected hospitalization, you or a family member will need to show the clinic your medical card (a small card the size of a credit card with your name and the number of your contract on it. The card will be given to you as soon as your contract has been issued).
If you do not have the card with you, contact +44 (0) 330 333 6686 (ALC) or email us at [email protected] (ALC, MetLife).
In case of scheduled surgery or hospitalization, please inform us of your intention as soon as possible (at least five days ahead).
This way we will be able to confirm whether your contract covers the expenses and if needed, we will contact your doctor. The decision of the insurance company’s medical council will be taken within 24-48 hours.
Outpatient Expenses
In order to file a claim for outpatient expenses, you will need to initially cover the costs of the clinic and medicine yourself.
You will subsequently have to gather any kind of written documents as proof you can provide (e.g. medical reports, invoices, payment receipts, test results, etc.), scan them, and email them to [email protected] (ALC) or [email protected] (ALC, MetLife).
You will also need to visit the site www.alchealth.com/library.htm (ALC contracts) and download a form called ‘Out-patient claim form’ which you can find under the category Claim Forms (if you face any difficulty doing that, you can email us so we can send you the form). The other relevant proof and the claim form must be sent in the same email together.
If you face any difficulty whatsoever with the whole process, you can gather all required documents and visit us in our office.
It is also worth mentioning that in the case of physiotherapy, no expenses will be covered unless there is a referral letter from a doctor.
Director Pitsas Insurances
06/01/2021
Limassol, Cyprus