DIRECT BILLING VS. CLAIM: WHAT IS THE DIFFERENCE?

DIRECT BILLING VS. CLAIM: WHAT IS THE DIFFERENCE?

There are two common ways health insurance claims are handled:

Direct Billing and Claims.

Understanding the difference can save you time and money.

1. Direct Billing

You receive treatment at a medical facility within the insurer’s direct billing network.

You present your insurance card and identification.

The medical facility submits a guarantee request to the insurer.

If the treatment and expenses are eligible under your policy, the insurer may settle the covered expenses directly with the medical facility.

You normally pay any expenses that are not covered by the policy.

2. REIMBURSEMENT

You receive treatment and pay the medical facility yourself.

You then submit the required claim documents to the insurer.

After reviewing the complete claim file, the insurer reimburses eligible expenses according to the insurance contract.

Example

Scenario A — direct billing

You visit a network hospital for outpatient treatment.

The hospital submits the guarantee request.

The eligible covered amount is settled directly with the hospital.

Scenario B — Reimbursement

You receive treatment at a medical facility where cashless service is not available.

You pay VND 3,000,000.

You collect the required medical and financial documents and submit a claim.

The insurer then assesses the claim and reimburses the eligible amount according to your policy.

Which one is better?

Neither is automatically “better.”

direct billing treatment is convenient because you may not need to pay the covered portion upfront.

Reimbursement gives you more flexibility when cashless service is not available.

The important thing is to understand where you can use cashless treatment and what your policy covers.