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isitatomic
April 11th, 2014, 22:46
Have been searching around for a real world example of someone's claim experience, no dice though. To anyone out there with experience filing a claim, a handful of questions have come up while I've been dealing with kidney stones. My supervisor hates her job and I've learned not to rely on her word for important health/money related stuff like this. While I wait for a bit of help from our PAs I figure I'd pick your brains in the meantime, if'n you have some experience with the matter.


First, my overall impression: That from my first trip to the emergency room for symptoms to my last visit and "full recovery", I am to meticulously keep receipts for all treatments and medicine, the sum total of which will be the amount of my insurance claim. Right? And...


1) Does the claim correspond to the full duration of treatment for a single illness, or to each individual visit/procedure/billing? Our red booklet notes that required costs are covered within 180 days from "first visit". My supervisor shot a dismissive "sore wakannai" at me when I tried to show it to her, and I think she is under the impression that I can claim only my one large bill from a single surgery, but not the peripheral smaller costs of diagnosis, hospital transfers, after-care, etc.


2) There is only space on the claim form for a single doctor and a single hospital. If you've visited several of each, have you just chosen one of each to fill out the form, or divide up the claims by hospital, or... ?


3) There's mention of a 30 day "report" window, something to be done before filing the actual claim after recovery. I'm assuming this is also in reference to 30 days from "first visit", just to sort of give the company a heads up that you are in the process of receiving care for something you plan to file a claim for later on. Yes?


Of course I don't expect you folks to have all the answers, but if anyone with experience making a claim can remember how it all went down I'd love to hear about it.

Lianwen
April 11th, 2014, 23:05
1) Does the claim correspond to the full duration of treatment for a single illness, or to each individual visit/procedure/billing? Our red booklet notes that required costs are covered within 180 days from "first visit". My supervisor shot a dismissive "sore wakannai" at me when I tried to show it to her, and I think she is under the impression that I can claim only my one large bill from a single surgery, but not the peripheral smaller costs of diagnosis, hospital transfers, after-care, etc.


It is from first visit. Luckily, the insurance covers everything, including transport, aftercare, transfers, etc. You just need to have the receipts from everything. If you don't have them all, the hospital you were treated should have a carbon copy (mine did). As long as you submit it within 180 days, you should be fine, but it can take 1-2 months for it to be processed into your bank account. It covers everything, minus the 5000yen copay.



2) There is only space on the claim form for a single doctor and a single hospital. If you've visited several of each, have you just chosen one of each to fill out the form, or divide up the claims by hospital, or... ?


I saw multiple doctors, but was at the same hospital. Honestly, my JTE at the time helped me fill out the form and I remember her filling out only one of the doctor names. The insurance company will call you and ask you for more details, too, they won't outright deny your claim.



3) There's mention of a 30 day "report" window, something to be done before filing the actual claim after recovery. I'm assuming this is also in reference to 30 days from "first visit", just to sort of give the company a heads up that you are in the process of receiving care for something you plan to file a claim for later on. Yes?

...I didn't need to do this. In fact, I filed in January, in the very last days of the 180, when I was sick past July.

The insurance people were incredibly nice and they called to check some things before they processed my application. I had pneumonia and received treatment/hospitalization for two weeks and was reimbursed everything I had paid out of pocket for, except for the 5000yen copay and my taxi for one of the days. I would have been reimbursed for the taxi, but I didn't have a receipt.

You can always call too. If your not sure of your Japanese, they did have an English speaker on staff, but I'm not sure how good their English is because my JTE did a lot of the communicating.

Feel better!

OH. I forgot! You also are capped on the amount you can make a claim for, depending on the injury/illness. I'm not aware though to what this cap is, but my pneumonia treatment cost 4man and that was reimbursed without question, minus copay. YMMV.

isitatomic
April 12th, 2014, 01:27
Thanks a million for the response, Lianwen. For your two weeks of pneumonia treatment, I'm assuming you were not actually admitted and in a hospital bed for two weeks, right? Yeesh.

When you were admitted, did you have to have someone sign under you as 家族somethingsomething on any forms? They gave me one to sign as a basic acknowledgment of the operation and anesthesia, and apparently someone has to be there for it? Assumed that would be the supervisor, but she is not the least bit interested in signing up for that and straight up told me "NOPE, find someone else".

Anyway, one of the peculiarities of having a stone is that I was showing up to those "designated emergency hospitals" that rotate daily for random hour pain attacks and initial diagnosis (first time doc sent me away saying I was just constipated.... yeah, no), so that by now I've had a nice tour of five hospitals and have receipts ranging from 1700 to 9000 yen. I think basically the supervisor sees them, looks at the 5000 yen insurance claim deductible, and applies it in an itemized way to each receipt thus discounting the cheaper bills. Assuming that taxi fare you mentioned wouldn't have been stupidly expensive, you just added your smaller bills to that final 4man total which is THEN reduced by 5000, right?

And thanks for the note about them having an English speaker on hand. My Japanese isn't the worst, but when it comes to big money and health issues I would definitely not want to completely rely on it!

Lianwen
April 12th, 2014, 09:06
It was really weird, but I stayed for the day. Now that I think about it, I don't think the inaka hospital I go to has overnights. I'd come in from 9-12 and then from 4-6, every day. I started taking a taxi (1600yen one way), but it got too expensive to pay out of pocket and I didn't realize my taxi was covered at the time or I would have asked for receipts, and took the bus instead when the taxi was too much.

I honestly don't remember signing anything. My BOE didn't want to have anything to do with me at that time, besides the first day I was diagnosed, so I went everyday by myself. I was first diagnosed with a cold though, but when my fever wasn't going down past day 3, the doctor gave me a chest x-ray. But, my supervisor could have signed something. I was so out of it and my supervisor and translator (who really couldn't translate, idk why he tried) paid for everything, with the intent I pay them back, without telling me and left me alone, so they could have signed something then. I didn't need surgery, though...I know in America, I've signed something like that for dental and permission to be put under and it's a legal thing. It might be the same in Japan, but I'm just throwing it out there.

Save everything that has a monetary value/looks like a bill. While it was the same hospital, for every day of treatment, I paid for it in the morning. It wasn't a lot (maybe 1200yen a day), but it added up. I also had shelled out 5k or so for when the doctor thought it was a cold. And 3k for the doctors note to excuse me from work. Everything was covered, including the doctors note. On the form, it should ask how much you paid in total (add up all your receipts) and then you submit your receipts. You also provide your bank account on the form. The company will send you a receipt when your claim is processed and will furikomi the money on that total line, minus the 5k deductible.

The x-rays were the bulk of the 4man, and were 8k. Because I didn't have receipts, my taxi fare wasn't covered, but I was told it would have been had I provided receipts. But, your supervisor is wrong to apply it in an itemized way, because it really doesn't work like that. The office was incredibly helpful and I wouldn't have even thought to put the taxi down as an expense, but the woman, through my JTE, wanted all my expenses, not just the hospital and pharmacy receipts. My bus fare was reimbursed without a receipt, no questions asked.

I hope that helps =3 I know I'm also not the only JET in my area who's gone through the accident insurance to get money back after being treated for pneumonia, and I also know someone who's had a broken arm treated and been recompensed. So, people def use the accident insurance. Hopefully someone else here has too and they can throw in their own situation.

isitatomic
May 27th, 2014, 11:22
Thanks for the comments, everyone. Stone blasted, further crisis averted. For a hearty chuckle go ahead and read the treatment description for ESWL on both a US and a Japanese hospital's website.

Some things for future reference.

First, if you drive yourself to the hospital/clinic, you will be asked to include a list of the one way driving distance(s) between your home and the place(s) of treatment. They will calculate how much you are compensated by the total distance driven, so do keep track. Also, when you are admitted to a hospital you are asked to bring a list of sleepover-ish items like towels, slippers, etc. If you keep receipts for any of these items that you had to purchase in preparation for being admitted, even food/needed items purchased in any little shops or konbinis in the hospital, you may add them to your total claim amount.

Second, if you find that the copay for a necessary procedure turns out to be prohibitively expensive you can submit an application to the Japan Health Insurance Association for a significant reduction in out of pocket cost. The cost of my surgery was roughly halved. Visit their website (https://www.kyoukaikenpo.or.jp/) for a wealth of information in Japanese on how to go about doing that.

Third, PLEASE DRINK WATER CONSTANTLY EVERY DAY. That is all.

therealwindycity
May 27th, 2014, 11:28
Glad you're feeling better! As for googling any treatment involving that area of the body though,

3699

isitatomic
May 27th, 2014, 11:36
Ho ho ho ho, your hesitation is understandable, young grasshopper. Sharpen your awareness and you will not simply learn Google-fu, you will become it.

The gist of it...

US Hospital - "There is some degree of pain experienced during ESWL, and general anesthetic is usually applied to prevent both pain and movement during the procedure."

J Hospital - "ESWL is not painful. Some pain medicine might be administered before the procedure. In some rare cases if total pussies need this done we will give them a local anesthetic."

Page
May 31st, 2014, 20:13
I had a friend who stayed in the hospital for over a week and it was completely reimbursed, not sure how much it had cost, though. Definitely not out of the question!

Mahjonggmania
July 7th, 2014, 18:00
I have been reimbursed through the workplace and JET accident insurance (or at least I will be once I find 2 M.I.A receipts) for

1) A 5 week hospital stay including room and "board" (food was typical hospital nasty), x-rays, medication and rehabilitation due to a completely broken ankle.

2) The emergency room visit and the ambulance ride.

3) The open reduction and internal fixation operation on my ankle.

4) All follow up visits and x-rays including the taxi fare to and from the hospital.


I have been given the deadline of October 5th to hand in all my receipts as well as the stipulation that they must be receipts (no claiming bus rides for me.)