Can You Get Insurance Claims for Using Non-Network Doctor Services in Hong Kong?

ARTICLE

Can You Get Insurance Claims for Using Non-Network Doctor Services in Hong Kong?

6-min read

In today's health insurance market, the concepts of "network doctors" and "non-network doctors" have become important considerations for insurance claims. As a leading insurance company, AIA Hong Kong provides comprehensive health insurance plans to its customers. However, many people still have doubts about whether using non-network doctor services is covered by insurance claims. This article will explore this issue in detail and answer your questions.

What is a Network Doctor?

Insurance companies establish partnerships with certain doctors and medical institutions to control the quality of medical services and improve service efficiency, forming a medical network. For example, AIA Hong Kong has established an extensive medical network covering over 800* affiliated doctors, encompassing numerous medical specialties and regions^1,2,3.

Advantages of Network Doctors

Using AIA Hong Kong's medical network^1,2,3 as an example, the advantages of network doctors include:

Simple Pre-Approval Process and Cashless Services:

Doctors and medical institutions that cooperate with insurance companies typically offer pre-approval services. This means you can obtain approval from the insurance company before receiving treatment, reducing the hassle of subsequent claims. Additionally, network doctors provide cashless services⁴, which means patients do not need to pay medical expenses upfront and then apply for reimbursement, thereby reducing financial pressure.

High-Quality Medical Services:

Network doctors are typically vetted and assessed to ensure their medical services meet standards. This means you can receive treatment with greater confidence, obtaining professional and high-quality medical services.

What is a Non-Network Doctor?

In contrast, non-network doctors refer to doctors or medical institutions that have not partnered with the insurance company. Reasons for choosing non-network doctors can vary, including personal preference, convenient geographical location, or certain specialist doctors only practicing at specific medical institutions.

Can You Get Insurance Claims for Using Non-Network Doctor Services?

This is a major concern for many policyholders. The answer depends on several factors, and the following points should be considered:

Policy Terms

First, you need to carefully read your policy terms. Different insurance plans may have varied reimbursement rules for non-network doctors. The actual situation will depend on the coverage details and insurance contract. For more information, review your policy’s exclusions and schedule or consult with your insurance provider.

Claims Process

The claims process for using non-network doctor services may be more cumbersome, as you need to submit more medical documents and expense receipts yourself. In contrast, using network doctor services is relatively straightforward, as the medical institution will directly liaise with the insurance company.

How to Choose the Right Doctor?

Review the Medical Network

Before selecting a doctor, you can check AIA Hong Kong's medical network to see which doctors or institutions are considered network doctors. This can help you better plan your medical expenses. Using AIA's "AIA+" app and its "Find a Doctor" feature can help you easily locate network doctors andclinics in Hong Kong, and designated hospitals in mainland China.

Consult an Insurance Advisor

If you have any questions about choosing a doctor or the claims process, it's advisable to consult AIA Hong Kong's professional insurance advisors.

Personal Preferences and Needs

Lastly, when choosing a doctor, consider personal preferences and needs. Some conditions may require treatment by specific specialist doctors. In such cases, even if non-network doctor costs are higher, they may be worth considering.

In summary, using non-network doctor services can still be reimbursed by insurance, but attention must be paid to policy terms, compensation amounts, and claims processes. AIA Hong Kong is dedicated to providing comprehensive medical insurance solutions, ensuring appropriate protection whether you choose network or non-network doctors.

Hopefully, this article can answer your questions about insurance claims for non-network doctor services, offering peace of mind when selecting doctors and medical services. If you have further inquiries, feel free to contact AIA's customer service center.

The above information is for general reference only. It does not constitute as an offer and/or insurance product recommendation. The product information in this webpage does not contain the full terms of the product. For details of the product features, terms and conditions, exclusions and key product risks, you may refer to the relevant product brochure and policy contract of relevant products.

Remarks:

This specialist network is not a contractual service (except for AIA Voluntary Health Insurance Flexi Scheme). It is offered at our absolute discretion and is subject to amendment, suspension or termination at any time without prior notice. The specialist network only provides medical services in Hong Kong.
This specialist network is only available to the eligible products, which include:

• OptimaCEO Medical Plan / OptimaCEO Medical Plan – First Gift, the standalone and rider versions of AIA Voluntary Health Insurance Prime Scheme, CEO Essence Medical Plan 2, CEO Essence Pearl Medical Plan 2, CEO Essence Medical Plan, CEO Essence Pearl Medical Plan. CEO Medical Plan 5, CEO Medical Plan (Worldwide) 5, CEO Pearl Medical Plan 5, CEO Pearl Medical Plan (Worldwide) 5, CEO Medical Plan 3, CEO Medical Plan (Worldwide) 3, CEO Pearl Medical Plan 3, CEO Pearl Medical Plan (Worldwide) 3, CEO Medical Plan 2, CEO Medical Plan (Worldwide) 2. CEO Pearl Medical Plan 2. CEO Pearl Medical Plan (Worldwide) 2. CEO Medical Plan, CEO Medical Plan (Worldwide), Regal Health Plan, Regal Health Plan (Worldwide), Executive Health Plan and Executive Health Worldwide Plan.

• Severe Illness Medical Protection Rider and Severe Illness Pearl Medical Protection Rider

• AIA Voluntary Health Insurance Privilege Scheme (rider), Privilege Medical Rider and Privilege Pearl Medical Rider.

• AIA Voluntary Health Insurance Privilege Plus Scheme (basic plan), Privilege Plus Medical Plan and Privilege Plus Pearl Medical Plan

This specialist network is effective after the policy is issued for 180 days (except for AIA Voluntary Health Insurance Prime Scheme, AIA Voluntary Health Insurance Privilege Scheme, Privilege Medical Rider, Privilege Pearl Medical Rider, AIA Voluntary Health Insurance Privilege Plus Scheme, Privilege Plus Medical Plan and Privilege Plus Pearl Medical Plan which will be effective from policy effective date).
You will be required to provide treatment information and authorize us to collect shortfall of medical expenses, if any, from your authorized credit card account.

Notes:

The list of eligible products will be updated at any time without prior notice.
All medical services, including those received in network, will be subject to the maximum limits of the relevant hospitalisation plan.
Please seek independent advice from doctors before receiving any medical treatment to ensure such treatment is suitable. In addition, the the medical services under specialist network are provided by network doctors, and they are all independent medical professionals, and not the employees or representatives of the Company. The Company shall not be held liable or responsible for any act or negligence in the medical services or treatment they provide.
The product information in this material does not contain the full terms of the products, for the details of the product features, terms and conditions, exclusions and key product risks, you may refer to the product brochure and policy contract of relevant products.

*These figures cover both individual and group medical plans, figures will be updated timely.

References:

Tsuen Wan Hong Kong-AIA Hong Kong Network Hospital [Online information] Source: https://www.twah.org.hk/tc/news-and-seminars/hkah-tw-the-aia-hong-kong-s-panel-hospital [Accessed September 10, 2024]

AIA Hong Kong [Online information] Source: https://www.aia.com.hk/content/dam/hk/zh-hk/pdf/health-care-claims/Specialist-Network-leaflet_tc.pdf [Accessed on September 10th, 2024]

HKAH-TW, the AIA Hong Kong's Panel Hospital

[Online information] Source: https://www.twah.org.hk/tc/news-and-seminars/hkah-tw-the-aia-hong-kong-s-panel-hospital [As of September 2024 Check on the 10th]

AIA Hong Kong [online information] Source: https://www.aia.com.hk/content/dam/hk/zh-hk/pdf/health-care-claims/Specialist-Network-leaflet_tc.pdf [in 2024 Accessed on September 10th]