Claims Process with Optimum Global

Optimum Global aims to provide a seamless claims process for its policyholders, ensuring that they receive the benefits they are entitled to with minimal hassle. Here’s a detailed overview of how to manage and submit claims:

Pre-Authorization and Notification

• Planned Treatments: Before any planned in-patient or daycare treatments, members must contact Optimum Global for pre-authorization. This ensures that the treatment is covered and avoids any unexpected costs.
• Emergency Situations: In emergencies where pre-authorization isn’t possible, members should have someone contact Optimum Global within 24 hours of hospital admission. Providing membership details and proof of identity at the hospital is crucial to facilitate immediate assistance.

Making a Claim

1. Claim Form: Members must complete a claim form, which is available from Optimum Global’s website or through their adviser.
2. Supporting Documents: Submit all relevant medical information, including treatment details and receipts. These documents must be submitted within 90 days of the treatment.
3. Submission: Scanned copies of the completed claim form and supporting documents should be emailed to [email protected]. Original documents might be requested if deemed necessary.

Payment of Claims

• Claims are reimbursed based on the currency conversion rate at the time of assessment. While Optimum Global attempts to reimburse in the member’s preferred currency, restrictions might necessitate payments in the policy’s administered currency.
• Optimum Global offers payment guarantees and direct settlements for in-patient claims if adequate advance notice is provided. Out-patient services are typically reimbursed to the member after payment.

Direct Settlements and Approved Hospitals

• Optimum Global has direct billing arrangements with many leading hospitals and physicians. Using non-approved hospitals or physicians will not invalidate a claim, provided the charges are considered reasonable and customary. Optimum Global may adjust benefits payable if charges exceed those of approved hospitals.

Contact Information

For claims assistance, members can reach Optimum Global’s 24-hour support line at +44 (0) 1892 772575 or via email at [email protected]. Click here to make a claim.

Additional Points

• Documentation: Ensure all necessary documentation is complete and accurate to avoid delays.
• Pre-existing Conditions: Claims related to pre-existing conditions might require additional verification.
• Arbitration: Any medical opinion disputes will be settled by medical experts appointed by both parties and, if necessary, an umpire.

By following these guidelines, members can efficiently navigate the claims process, ensuring timely reimbursements and access to necessary medical care. For more detailed information, refer to Optimum Global’s membership guide or contact their support team.