Why do you need to read this?
Bulgarian insurance companies (and medical institutions too) have their own features which raises not only many questions, but also a certain amount of surprise – is it possible? Unfortunately, the “ceiling” of professionalism at the level of insurance companies cannot be “overridden”. We, as the end users of insurance products, have to act in a difficult situation dealing with the issues of refund of insurance claims. The overall situation is not only characterized by a lack of proper attitude to each insured case, but also by “negligence” at many levels, loss of data, attempts to evade responsibility at any slightest chance. Therefore, we should constantly expand the FAQ base. This article, in our opinion, is necessary to be read, to understand the full image of what we should wait at different stages of interaction with insurance companies in Bulgaria. We partially provide an redundant list of actions, but in some cases these actions will not be superfluous, although they will force you to spend time. We strive to ensure that you receive your payment, regardless of where you insured. Our strategic goal is to increase the level of responsibility of insurance companies in Bulgaria.
How to get prepared to an insured accident?
Yes, this is the way to raise the question in dealing with any medical insurance. Although we always hope for the best, it still makes sense to seriously prepare for the onset of adverse circumstances. We suggest to:
- Record the insurance policy No.
- Record the insurance company telephone.
- Remember the emergency telephone (112).
- Be ready for the fact that English is spoken on the phone of the insurance company only if there are English-speaking operators in the current call-center workshift. The same situation is frequent for Russian.
- Read the following articles at our website:
– Effective use of health insurance for foreigners in Bulgaria.
– Guaranteed rejection of refund under compulsory health insurance for foreigners in Bulgaria.
– Document samples in medical institutions in Bulgaria.
– General information on the coverage of sports/labor risks under compulsory health insurance for foreigners in Bulgaria.
What to do at the occurrence of an insured accident?
- Call the insurance company and report the accident. Make sure to have obtained the claim ID (“номер на претенция” in Bulgarian). If the accident does not let you spend time for this, get back to this later. Proceed to par. 2 Attention! The call-centers of insurance companies in Bulgaria do not work at night and on weekends. The exception is the Armeets Insurance Company operating via the CORIS assistance service.
- Call the ambulance 112 or get to the hospital by you own.
- Collect the documents the hospital will issue according to the list on the link below and submit it when requesting for refund.
The information which we provide via the link is preferable to be read in advance and to be printed (a PDF is attached at the end of the article): Effective use of compulsory health insurance policies for foreigners in Bulgaria
How to be sure that the insurance event is registered by the insurance company?
Unfortunately, there are facts of loss of data when calling to the insurance company. In this regard, make sure to ask for the claim number (in Bulgarian “номер на претенция” / “Claim ID” in English) and keep it for yourself. In addition, make the mobile phone screenshot, which would show that you called the insurance company and do not forget the number you called from. If you can not to make a screenshot, then make yourself a note with the exact date and time of call, the phone number you dialed, the phone number you called from and your claim ID. You may need all the above. Also, find the contact email of the insurance company and send an email thereto. For the list of insurance companies with their websites see here. The list is not exhaustive! There you will also find the postal address of the insurance company. Notify them by registered mail (with the acknowledgment of receipt) about the event happened. Send this letter within 2 to 5 days after the occurrence of the insured event.
What should I know about the insurance claim procedure?
Our many years of experience suggests that insurance companies after receiving the refund documents, usually act according to the following script:
- They check the correctness of the insured person personal data indicated in the insurance policy and in the documents issued by the medical institution. No typos may be paid attention to, but such items as birth date and/or passport number should be paid attention to. In case of non-compliance, the payment may be refused.
- They check whether anyone has contacted the call-center to report the event. If no one, the insurance company may refuse to refund or halve the payment amount.
- The event is checked to be an insured accident. Of course, if the case is covered by insurance or it occurred under circumstances precluding insurance refund, the applicant will be refused.
- They check whether the medicines were bought immediately after the doctor’s prescription or with a certain delay. If the medicines were purchased within 2 to 3 days, it’s OK. If later, they may deduct the medicines’ price from the refund amount.
- They check whether all prescribed drugs are medical preparations, and not biologically active substances. Therefore, if the doctor prescribes homeopathic medicines or dietary supplements, their cost is not refundable.
- If the company has documented reasons to refuse, a rejection is formalized. If there is documented reasons to doubt the occurrence of the event covered by insurance, the insurance company tries to refuse the refund supporting this by such documents. The rejection is sent to the claimant.
- If the claimant, in the event described in par. 6, who has received a refusal, continues to prove his righteousness, to provide additional information and/or documents, insists on refund, the insurance company offers a payment of 50-80% of the amount to refund.
- Further actions of the insurance company depend on the insistence of the insured person, on the insured accident and the related circumstances.
How to get the list of medical institutions cooperating with the particular insurance company in Bulgaria?
In Bulgaria, insurance companies post at their websites neither any detailed information about insurance for foreigners in Bulgaria, nor the lists of medical institutions cooperating with their company on the basis of direct payment. And this can not be helped. As for themselves, insurance companies when contacting their call-center asking about the list of institutions, say something like this: “Contact us when the insured event occurs and we will advise you where to go.”
What to do if the insured person has no money to cover the cost of clinical services, if this medical institution does not have a direct contract for the provision of medical services under insurance policy?
Firstly, you should know that no one may detain you if you have not paid for the services, at the clinic where you stayed. (Yes, such cases were also encountered throughout our experience!!) If such event, you can call the police (112) and state that you are being illegally detained.
Secondly, contact your insurance company or broker/agent who sold to you the insurance policy and tell them about your problem. Insurance companies often send a letter of guarantee after checking the primary documents in an insured case, after which they make a direct payment to the clinic.
What are the obvious infringements in the work of insurance companies and where to complain for?
The Financial Supervision Commission is the authority who, without limitation, is responsible for monitoring the compliance of insurance companies with the term and fulfillment of mandatory procedures. Our special article at our website covers this topic.
What are the reasons why my refund documents may be rejected?
As a rule, insurance companies accept documents by mail and in case of their shortage; they send a sound refusal or the request for additional documents. Such is the procedure established by the Financial Supervision Commission. Collect the required documents carefully and scrupulously so that your refund is not delayed.
What document defines insurance conditions for foreigners in Bulgaria?
What to do if I have bought a fake insurance policy?
We encounter, although not often, the cases of selling false policies. In such case, we suggest contacting the insurance company whose fake policy you bought. And to the police too. In the future, you can only protect yourself from this by preventive measures. Do not buy insurance policies from suspicious individuals and entities. You should be especially careful if their offer is cheaper than the average in the market.