Understanding Our Medical Network

This post is an answer to the question: ‘What is William Russell’s medical network?’

The post is written for insurance brokers and intermediaries. It explains how our network of clinics and hospital works, how members claim for inpatient and outpatient treatment , and provides links to pages, resources, and online tools that we share with our members.

Our medical network

In discussions with brokers and members, I’ve received feedback that the William Russell medical network isn’t strong, that we don’t make it clear where members can receive treatment, and that our claims process isn’t clear.

Over the past few months, my team has been working hard to improve our resources for hospitals, networks, and claims. This post highlights the fruits of that labour and clears up a few misconceptions I’ve encountered concerning our claims service delivery.

I’ve divided the post between our three main types of claims service delivery: claims for inpatient/daypatient treatment, claims for outpatient treatment, and emergency medical evacuations.

Inpatient & daypatient treatment

Inpatient treatment is medical treatment a member receives that requires their overnight admission to hospital. Sometimes they might be formally admitted to hospital, but they don’t need to stay overnight. This is called daypatient treatment.

In what follows, I use only the term ‘inpatient treatment’. But what I write applies equally to daypatient treatment.

How claims work for inpatient treatment

Members can use any hospital in their coverage zone. In that sense, we’re quite unlike those insurance providers that require their customers to seek treatment only at hospitals in a certain network.

The freedom that our members enjoy to choose a hospital or clinic is one of the main advantages of a health insurance policy with William Russell.

As soon as a member knows they need medical treatment that requires admission to hospital, we ask them to complete our online pre-authorisation form. We ask members to complete the form at least 5 working days before the proposed admission date, and we’ll respond to the member within 1 working day.

We then contact the hospital where the member will be receiving treatment. We ask the hospital for the necessary medical information, and—if the member’s plan covers the proposed treatment—we’ll attempt to send the hospital our guarantee of payment (GOP).

By ‘attempt to send’, here’s what I mean: Though we permit members to receive treatment at any hospital in their coverage zone, we do have a network of hospitals that accept our GOPs for inpatient treatment. If the member seeks admission to a hospital that isn’t in our network of hospitals, we work with our partners at the Charles Taylor Group (formerly known as CEGA). The Charles Taylor Group has a vast network of hospitals that accept their GOPs.

Occasionally, a member seeks admission at a hospital that forms neither part of our network nor part of Charles Taylor Group’s network. For instance, remote clinics in certain parts of Africa cannot handle international payments and will not accept GOPs from any insurance provider. In these cases, we work with local agents to find a solution for the member.

Once the member is admitted to hospital, we settle the bill for their treatment directly with the hospital.

*Please note that this tool does not show hospitals and clinics that form part of our network for cashless access to outpatient treatment. For information on the cashless service, please see below.

Other resources we provide to members

Here are some resources related to inpatient treatment that we make available to our members:

• Our benefits for hospital treatment & accommodation
• How claims work
• What is pre-authorisation?
• Our online pre-authorisation form
• How coverage zones work

Outpatient treatment

Outpatient treatment is medical treatment a member receives that doesn’t require their admission to hospital. The term ‘outpatient treatment’ encompasses everyday medical care such as doctor visits, physiotherapy sessions, and emergency ward treatment.

Pay & claim

We ask members to pay the bill for their outpatient treatment, then claim back their expenses from us later. This practice is sometimes called ‘pay and claim’, or ‘reimbursement claiming’.

Before a member receives treatment, we invite them to check with us whether their plan covers their proposed treatment. Certain types of outpatient treatment we need to pre-authorise in the same way as inpatient treatment.

When a member receives outpatient treatment, we ask them to request a fully itemised invoice from their treating doctor. The member then pays the invoice, keeping a copy of it and the payment receipt.

When the claim exceeds US$500 (or equivalent in another currency), the treating doctor must also complete a PDF form.

The member then needs to complete our online claim form, which allows them to upload a photograph or scan of the invoices, receipts, and any other relevant documents.

We then reimburse all the members medical expenses. Our typical turnaround time for reimbursing claims for outpatient treatment is 5 working days.

Cashless access to outpatient treatment

Some members are eligible for cashless access to outpatient treatment, which means we’ll settle their bills for outpatient treatment directly with the clinic when they seek treatment at a clinic in our network.

Previously called ‘direct billing’, we renamed the service as ‘cashless access’ in early 2024. We think cashless access is more descriptive, and helps distinguish from direct billing for inpatient treatment, which I described above. Other insurance providers variously call the service ‘flash-the-card’ or ‘direct billing’.

With cashless access, members can receive outpatient treatment at hospitals and clinics in our network without paying from their own pocket.

Here’s our network of hospitals and clinics.* Note that our network is strongest in Hong Kong, China, and Singapore.

*Please note that this tool does not show hospitals and clinics where our members can receive inpatient treatment. For information about hospitals our members can use, please see above.

We include cashless access as standard for all eligible members. The eligibility criteria are as follows:

• Member must have a SilverLite plan, a Silver plan, or a Gold plan
• Member must have a nil excess or a US$50 / £30 / €45 per claim excess
• Member must be resident in one of the following countries: Cambodia, China, Hong Kong, Laos, Malaysia, the Maldives, Myanmar, the Philippines, Singapore, Sri Lanka, Thailand, Turkey, Vietnam, United Kingdom

It’s important to note that members can only use the cashless service to access eligible outpatient treatment covered by their plan. If a member isn’t sure whether their proposed treatment is eligible, they should confirm their coverage with us.

If a member receives treatment that’s not covered by their plan, they’re liable to pay back to us the cost of their treatment.

Other resources we provide to members

Here are some resources related to outpatient treatment that we make available to our members:

• Our benefits for outpatient treatment
• Our well-being benefits
• How claims work
• Our online claim form
• Our cashless access service
• How coverage zones work

Medical evacuation

If a member suffers a life-threatening or limb-threatening injury or illness that needs immediate inpatient treatment that isn’t available locally, we arrange the member’s evacuation to the nearest suitable location.

If the member has Medevac Plus, we lower the threshold for evacuations. We evacuate a member with Medevac Plus who needs advanced diagnostic tests or cancer treatment that cannot be provided locally.

When we organise a medical evacuation, we evacuate the member to the nearest suitable hospital in the member’s coverage zone. We won’t evacuate to a country where, under the terms of their coverage zone, the member is only eligible or restricted cover. We never evacuate to the USA.

We organise the evacuation destination and the means of transport that best suit the member’s interest. We take several criteria into account, including the severity of the member’s condition, air ambulance availability, and the member preference.

We handle all aspects of the evacuation, including liaising with medical teams on the ground, logistics, securing admission at the destination hospital, and handling any passport/visa issues.