System for payment of medical care costs
Once you have shown your health insurance card for medical care, the medical care institution bills the Health Insurance Society monthly for the medical care costs covered by insurance. Note that it would be a highly complex undertaking for all medical care institutions and health insurance societies to handle such billing and payment individually.
Accordingly, billing and payment of medical care costs is carried out through healthcare bill check and payment organizations such as the Health Insurance Claims Review & Reimbursement Services (HICRRS). The Health Insurance Society is billed for medical care costs about two months later. Other payments,such as payment of benefits from health insurance to individual members, also takes place at least three months after the month of the medical care.
Flow for payment of medical care costs
- Undergo the examination（A）, present your insurance card to the healthcare provider, pay 30% (general) of the medical expenses after you have received treatment. （B）
- The healthcare provider bills the Health Insurance Claims Review & Reimbursement Services (hereinafter "Review & Reimbursement Services") for the remaining 70% (general) of the medical expenses.（C）
- Review & Reimbursement Services checks the statement of medical expenses (health insurance claim) submitted by the healthcare provider, then bills the Health Insurance Society.（D）
- If there are no mistakes in the billing statement, the Health Insurance Society pays the healthcare provider through Review & Reimbursement Services.（E,F）
The reasons for using this type of system are as follows.
- If the Health Insurance Society is billed directly for medical service fees by each healthcare provider and makes the payments, the work of the Health Insurance Society and the healthcare provider would be troublesome. To reduce the burden of office work and to avoid confusion
- To implement review of the billing statements sent by each healthcare provider to ensure appropriateness accurately and efficiently
The Health Insurance Society reviews the health insurance claims that were reviewed by Review & Reimbursement Services, and strives to make suitable medical expense payments and utilize insurance premiums effectively.