The process of seeking medical opinions from outside specialists on whether it is appropriate to pay insurance benefits will be improved so that medical consultations are conducted through the Korean Medical Association Organization.
The Financial Supervisory Service said on the 4th that Governor Lee Chan-jin and Korean Medical Association President Kim Taek-woo signed a business agreement to enhance the objectivity of medical consultations related to insurance benefits.
Going forward, policyholders will be able to choose the medical association as the medical consultation institution. If an insurer requests a consultation from the medical association, the association will independently assign a consulting physician in consultation with the relevant academic society.
To that end, the medical association decided to form a medical consultation panel with specialists affiliated with tertiary general hospitals or general hospitals. The medical consultation panel will consist of at least five members per department. The Financial Supervisory Service (FSS) said it will pilot this form of medical consultation only for matters related to cerebrovascular and cardiovascular diseases and orthopedic aftereffects under fixed-benefit policies, excluding indemnity health insurance, and then gradually expand it.
Medical consultation is a process of asking an independent specialist for a medical opinion on whether the customer received excessive treatment and filed a claim for insurance benefits. Policyholders can receive consultations only at hospitals designated by the insurer. However, there has been widespread criticism that consultation institutions, due to their interest ties from consultation contracts with insurers, render judgments favorable to insurers.