Insurance representatives: how and for whom they work

– Insurance representatives are specialists of the insurance company with the necessary knowledge in the field of legislation to protect the rights of the insured. They interact effectively with patients and help with any difficulties. The list of duties of an insurance representative includes advice and assistance in choosing a doctor, quality control of medical care provided within the CHI system.

In addition, the insurance representative, on the basis of a written application from the insured, decides the issue of refunding funds if money was illegally collected from the insured in a medical institution. Experts remind about the passage of preventive measures and medical examination. That is, these are universal assistants for those who receive medical care under the compulsory medical insurance policy.

– The introduction of such a system is not a quick process. The first stage of the project started on July 1, 2016. Then the insurance representatives of the first level started to work. Their tasks include consulting the insured about the rights and procedures for the provision of medical care in the CHI system. They also inform those who applied about the possibility of taking preventive measures.

And a little later, from the beginning of 2017, insurance representatives of the second level began to work. They inform the insured when receiving medical care, including preventive measures, and also protect their rights and legitimate interests in the field of compulsory medical insurance.

Since January 2018, insurance representatives of the third level – qualified specialists and experts of the quality of medical care, have joined the information support of the insured. When the insured applies, they analyze the timeliness of dispensary observation, planned hospitalizations and, if necessary, assist in organizing the provision of medical care to the insured. It should be noted that insurance representatives of the third level are highly qualified medical experts. And such specialists are already working in the SOGAZ-Med company.

– In my opinion, it is too early to sum up the results. Many of the insured are not yet accustomed to the new status of specialists in insurance companies.

But I can say with confidence that the institution of insurance representatives has become one of the key channels for insured citizens to apply for the protection of their rights in the CHI system. In 2017, the total number of calls to SOGAZ-Med exceeded 2 million 700 thousand. At the same time, almost 700 thousand applications were received orally – through insurance representatives in medical organizations and company offices, as well as through calls to the contact center. About 2 million more applications were received in writing – through the official website of the company and the applications of the insured SOGAZ-Med. Thus, the number of insured requests increased by 13,04% compared to the previous year – an excellent indicator that reflects the effectiveness of the company’s interaction with the insured.

In 2017, the St. Petersburg branch of SOGAZ-Med received about 30 applications from the insured. This indicator indicates that with the introduction of the institution of insurance representatives, citizens began to more actively apply to medical insurance companies to protect their rights.

– The most frequently insured people ask questions on the following topics:

– about the quality of medical care;

– on the legality of the collection of funds for medical care provided under the compulsory medical insurance programs;

– on the organization of the work of medical organizations;

– on the choice of a medical organization;

– on the legality of refusing to provide medical care to a patient under the compulsory medical insurance program.