INTERMEDIATE COURSE IN MEDEICAL & HEALTH INSURANCE - NON MEDICAL ASPECTS OF CLAIMS

 

Key learning Outcomes

At the end of the course, participants will be able to :

•explain the key terminology/definition and calculate the various elements of the Hospital & Surgical Insurance benefit structure.
•match the various expense items to their respective benefit category and to calculate the amount of admissible and non-admissible claims.
•explain the situation where an upgrading of room becomes medically necessary.
•explain the meaning of specialist, customary and reasonable charges.
•explain M&H claims procedures and assessment.
•state the various warning signs relating to possible fraud.
•identify and state the responsibilities of the various parties involved in using, delivering and financing healthcare.