Claims, networks and the future of health insurance
Written by Laura during a team gathering in Bali
At SafetyWing, we aim to simplify the complicated language of health insurance by avoiding overly technical terms and obscure rules about what is and isn’t covered by a policy.
We’ll break down one of the most common questions members have — What is the difference between claims and networks?
What is a claim?
Whether you’re using SafetyWing or another provider, an insurance claim is a request for reimbursement after paying for covered services. For example, if you stay in the hospital overnight, you would pay the hospital bill yourself, save your receipt and submit a claim to your insurance provider. If the claim is approved, you’ll be repaid.
Pros & cons
🟢 The main benefit is freedom — with Remote Health & Nomad Insurance, you can go to any clinic or hospital you’d like. Depending on your insurance provider, you won’t have to contact them before seeking treatment.
🔴 The downside is paying out-of-pocket for the treatment or service. Around 30% of the people we speak to mention that they often don’t have the money on hand to pay for unplanned healthcare.
Another major concern is that reimbursements take too long to process. While many insurers now promise to process claims within 5-7 working days, payouts can take additional time.
What is a network?
Some insurers partner with a group of clinics and hospitals to provide healthcare services to their customers.
Pros & cons
🟢 Pay little or nothing out of pocket. Your insurer will typically sort out the payment for you.
🔴 Users are only covered in full if they use the specific hospitals, clinics, and providers within their insurer’s network. Using a provider outside of the network may cost the user more out of pocket or may not be covered at all.
Networks are restrictive. Your covered hospitals may only be available in a certain area, so you might have to travel or wait a long time for an appointment. Worst case, it could delay your treatment in an emergency.
Since the insurance company has to be a middleman between the medical facility and the user, processing times for procedure approvals can be slow and could lead to higher prices.
What about universal health coverage vs. private hospitals?
Some countries have universal health coverage. That means all legal residents have access to the quality health services they need, when they need them. Free, quality healthcare is the main benefit, but the downside is potentially long wait times to receive treatment and lack of coverage for certain types of services.
People with access to universal health coverage may also choose to buy private health insurance. This gives users quicker access to health services with the option of using private providers.
The future of health insurance
Roman Heindorff, GM of Remote Health, explains the future of health insurance and how we are building towards it.
“An ideal health insurance would offer the benefits of claims (freedom to go to any hospital) with the benefits of a network (no user payment required). What we’re building for our members is the best of both worlds, without the restrictive drawbacks of each.
What’s more, we design our products to adapt with changing market conditions for employment. These include increasing globalization, worker mobility (geographically as well as between employers), and the rising gig economy. We are building a product flexible enough to cover all these different individuals and situations as the world continues to change.”
