Report of loss: health insurance for foreigners

Getting sick or having an accident in Poland can take you by surprise, especially if you are here as a foreigner and unfamiliar with local procedures. In practice, „reporting a claim” in health insurance means providing the insurer with information about the incident and documents that confirm the treatment and costs incurred. Only on this basis can the company assess whether a benefit is due and in what amount.

In this guide, I explain how to conduct a health insurance claim step by step, what to watch out for and what documents to prepare. I will also focus on typical situations faced by foreigners in Poland: reimbursement, lack of PESEL number, documents in another language or contacting assistance.

Before you send in your paperwork, determine what model your health insurance operates under. Two most common scenarios are encountered in policies for foreigners: non-cash settlement by assistance or reimbursement (refund) after paying for the visit out of pocket. It depends on what you report and when.

In the model assistance You usually call the assistance center, which arranges the visit, indicates the facility and confirms the coverage guarantee. In the model refunds key are bills/invoices issued to the insured and proof of payment. The T&Cs also often require that cost documents include patient and facility data and confirmation (e.g., stamp and signature of an authorized person).

Deadlines vary from one company to another, but the principle is similar: the claim is to be reported as soon as you learn of the insurance event. In the T&Cs, you can find short deadlines for some events (e.g., 24 hours) and longer deadlines for sending full documentation. If you delay, it may be difficult for the insurer to determine the circumstances of the event, which is sometimes grounds for limiting the payout.

On the other hand: even if you don't have all the documents yet, report the damage right away and only then complete the attachments. In many procedures, the company, after accepting the application, will tell you what documents are needed to further the case.

The most common channels are the insurer's online form, e-mail, call center and customer panel. Sometimes it is the company that indicates a dedicated email address for claims or a hotline number for medical reports. After reporting, ask for confirmation (case number), as this will facilitate later communication and docketing of documents.

If you are interested in how to get help quickly in practice, see also the guide: how to get medical help.

The chart below fits most health and travel policies covering medical expenses in Poland. Treat it as a checklist. If your T&C requires additional documents, include them right away so as not to prolong the process.

In practice, the insurer requires two groups of documents: medical and financial. The T&Cs often require the submission of an information form and documentation describing the medical condition and course of treatment. Also important for reimbursement are bills/invoices issued by name to the insured, and sometimes additionally proof of payment.

If the facility issues paper documents, make sure the bill includes your data, the facility's data and the signature/stamp of the authorized person. This is especially important if you are a foreigner in Poland and the insurer verifies that the cost actually applies to the insured.

The procedure is similar for all, but foreigners in Poland More often, they face organizational obstacles. The most common are: no PESEL, medical documents in a language other than Polish/English, illegible bills, or no proof of payment. The good news is that most of these problems can be solved right away if you know what to ask the facility for.

If you are receiving private treatment, ask the registry for a named invoice with your address and an itemization of the service (e.g., consultation, examination, procedure). If you pay cash, keep the receipt and ask for a receipt of payment for the invoice. If the documents are in another language, ask the insurer if it requires a certified translation or if a simple translation will suffice (this often depends on the type of claim and amount).

In the context of residence formalities, the article may also be helpful: health insurance and residence card.

The processing time depends on the complexity of the case and the completeness of the documents. In practice, many companies aim to issue a decision within a few dozen days of receipt of the notice, and if the case requires additional findings, they will inform the reasons for the delay. Often the so-called undisputed portion of the benefit is also paid, when part of the claim is not in doubt.

If you get a denial or the amount is lower than you expect, ask for a written justification and an indication of the missing documents. Then file an appeal, attaching additions (e.g., a more complete medical history, additional test results, payment confirmations). In many situations, the problem is not a lack of coverage, but a lack of information needed to evaluate the claim.

When you want to better understand what the policy typically covers, read also: health insurance – what to look out for and scope of health services.

Effective damage report z health insurance It comes down to three things: prompt information to the insurer, complete medical records and correct cost documents. For foreigners in Poland, the most important thing is that the bills are named and legible, and the description of the treatment includes the diagnosis and recommendations. If you have the opportunity, use assistance, as it often allows you to avoid paying upfront.

If you need support in selecting a policy or want to make sure what documents will be required in your situation, contact medical-insurance.co.uk via the form on the website: contact.