[Becoming an Insurance Insider] COVID-19 Diagnosis Fees: Claiming Reimbursement from Actual Expense Insurance Is Useless

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[Asia Economy Reporter Oh Hyung-gil] Some hospitals are charging consumers for COVID-19 testing fees, requiring caution. The government covers the full cost of testing when medical staff recommend the test or if the patient is suspected of infection.

On the other hand, if an individual voluntarily gets tested without a doctor's recommendation, they must bear the cost themselves, and this is not covered by indemnity health insurance.

According to the insurance industry on the 5th, although the government supports the testing fees, there have been cases where insured individuals who paid COVID-19 testing fees due to hospital errors are claiming insurance benefits from non-life insurance companies.

Currently, the government supports testing fees when medical staff recommend the test or if the patient is suspected of infection. This includes cases such as patients with unexplained pneumonia requiring hospitalization based on a doctor's opinion, who develop fever or respiratory symptoms within 14 days after contact with a confirmed case.

Regardless of the COVID-19 test result, testing fees are supported, and confirmed patients receive full medical expense coverage from testing fees to treatment costs.

Conversely, if a person voluntarily gets tested out of anxiety without a doctor's recommendation or opinion, they must bear the cost (160,000 to 200,000 KRW). Even if they test positive, they initially pay the cost themselves, but the government supports treatment costs and may reimburse testing fees later.

Notably, in both cases, COVID-19 testing fees are not covered by indemnity health insurance. The standard terms of indemnity insurance specify that 'testing costs unrelated to a doctor's clinical opinion' are not compensated. This means that even if the patient pays medical fees out-of-pocket at the hospital, they cannot receive insurance benefits.

However, if another disease is discovered during the COVID-19 testing process, the medication and medical fees for that disease can be covered by indemnity insurance. If the insured has disease insurance that covers specific illnesses, they may receive insurance benefits according to the contract terms.

Also, if a confirmed patient is hospitalized and has subscribed to a fixed-amount insurance product that guarantees a daily hospitalization allowance, they can receive insurance benefits. A fixed daily allowance is paid according to the number of hospitalization days.