Tips about hospital rooms and insurance
Hospital rooms are typically listed under Inpatient or Hospital Benefits as “hospital room and board.” Here are some things you should know when it comes to hospital room levels and health insurance.
Tip #1: Medical fees are linked to hospital room class
In Hong Kong’s private hospitals, all medical fees are linked to the class of room you stay in, so the more expensive the room, the pricier the fees for the medical services you receive during your stay.
This means if Sarah is staying in a private room, and John is in the standard ward, but they’re both undergoing the same surgery and receiving the same medication, Sarah will be charged more for the same services solely because of her room type.
Tip #2: Stick to your room level to avoid claim issues
Because medical fees are linked to room type, it is very important to stay in a room from the class specified in your Inpatient or Hospital Benefit.
For example, if your Hospital Benefit entitles you to stay in a semi-private room, but you opt for a private room instead because you’re willing to pay for the difference out of pocket, it is unlikely that your insurance provider will cover the entirety of your other hospital expenses. That’s because staying in the more expensive room drives up all the other medical fees during your hospitalization.
In fact, most health insurance providers have a provision stating that if you choose a room level higher than the one stated in your Hospital Benefit, then they will reduce, by a certain factor, the benefit paid.
Tip #3: Verify your room coverage with your insurer
Make sure you have a clear understanding of your insurance coverage for hospital room and board. This way you are less likely to run into surprises. The best way to be sure is to contact your insurer for confirmation.
For example, private rooms vary greatly in style, size, and luxury. Most have a daily room rate falling between HK$1,800 and HK$6,700, but “VIP rooms” like the 37th-floor suite at the Hong Kong Sanitarium & Hospital costs HK$23,000 per day. You will want to check with your insurer beforehand to see if they will agree to cover such high costs when many more economical single-occupancy rooms are available.
Tip #4: Some “semi-private rooms” are actually private
In addition to semi-private double rooms, some hospitals – like Gleneagles Hong Kong Hospital, Precious Blood Hospital and Evangel Hospital –also provide semi-private single rooms.
In a semi-private single room, you’ll have the room all to yourself, although you might have to share the bathroom with another patient.
Balancing comfort with a budget-friendly price makes semi-private rooms an appealing choice for employee health benefits packages, allowing employees to recover in privacy.
Tip #5: If you get upgraded to a more expensive room because there are no more beds, your hospital or insurer might cover it
If your plan only covers semi-private rooms but you get upgraded to a private room because there are no semi-private beds available, then the hospital might cover the cost of the upgrade. If not, then your insurance provider might cover it – as long as the hospital provides a letter explaining that no beds were available at your room level at the time. Check with both your hospital and insurance provider for clarity around the fee situation.
Tip #6: Contact your insurer about your hospitalization beforehand
If you need to stay in a hospital for surgery, contact your insurance provider ahead of time to let them know. If the procedure is covered, they can arrange to pay the hospital directly. For some insurers, pre-authorization is actually required before surgery and a hospital stay, otherwise a co-insurance may be applied even if your policy covers the procedure.
Once your insurance provider receives your head’s up, they will liaise with your hospital to validate the procedure and costsand grant pre-authorization. Next, they will issue a guarantee of payment, confirming that the insurer will pay the hospital directly. You will need to present both the pre-authorization letter and guarantee of payment when you are admitted.
Note that the pre-authorization is only a preliminary assessment, so the final amounts may differ from the estimate. The final claim payment is up to the insurance company’s discretion.
Tip #7: Hospital stays require a deposit
Staying in the hospital requires a deposit, which varies in amount depending on the hospital, room type, and whether the patient is a resident or non-resident of Hong Kong. If you contact the insurance provider before your hospitalization, they will arrange the pre-authorization and guarantee of payment and handle the deposit.
Tip #8: Facilities vary by room level
Facilities in each room depend on the level of the room. Generally, the higher-end the room, the more comprehensive the facilities. Most hospital rooms come with a washroom, TV and wifi. Some include an electronic safe, a mini fridge, and a sitting area for visitors. High-end rooms might have a living room or a panoramic mountains and sea view.
Tip #9: Pay attention to what’s NOT included in room charges
Generally speaking, hospital room charges in Hong Kong typically only cover accommodation. Anything on top of that depends on the hospital. For example, some room fees might include accommodation for a companion, while others might charge separately.
Room charges typically do not include other medical fees, like injections, medicines, diagnostic tests and scans, treatment, operating theater costs, surgery, doctors’ fees, private nurses’ fees, etc., as well as meals and companion beds.
You will want to verify all of this to avoid issues with insurance claims. For example, even if a hospital offers a meal service, food might not be included in the room and board fee. And even if the insurer agrees to cover meals, coverage might be restricted to food consumed by the patient and not by visitors. Further, if the cost of food is unreasonably expensive considering the condition of a patient, the insurance company might investigate and decline to cover that cost.
Tip #10: Insurance companies only cover hospital stays for procedures that are “medically necessary”
Your health insurance plan should cover hospitalization –including room and board –for any surgery that is deemed “medically necessary. Because each insurance provider has its own criteria for “medically necessary”, it’s a good idea to check with your insurance advisor or agent to make sure they will cover your surgery beforehand.
It’s also important to make sure that the surgery is not part of your policy’s exclusions and that there is no waiting period or moratorium in your policy. For example, most policies will not cover surgeries for a pre-existing condition.
The following surgeries are unlikely to be covered by insurance because they aren’t deemed “medically necessary.”
- Breast augmentation/reduction for cosmetic purposes
- Tummy tuck for cosmetic purposes
- Weight loss surgery for cosmetic purposes
- Gender reassignment surgery
- LASIK surgery
If you are hospitalized for a surgical procedure that is not medically necessary, not only will they decline to cover the procedure itself, it is also very likely that they will decline to cover your room and board.
