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Dentistry 20 - Health insurance and billing
Dentistry 20 - Health insurance and billing
Dentistry 20 - Health insurance and billing

Dentistry 20 - Health insurance and billing - Exercises

Seguro de salud y facturación

Exercise 1: Match a word

Instruction: Match the items that have a related meaning.

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La póliza — El contrato del seguro (The policy — The insurance contract)
La cobertura — Lo que está incluido (The coverage — What is included)
El asegurado — La persona asegurada (The insured person — The insured individual)
La autorización previa — El permiso previo (Prior authorization — Prior permission)

Exercise 2: Exam preparation (QR: Audio)

Instruction: Read the text, fill in the gaps with the missing words, and answer the questions below

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Aviso de facturación y reembolso (seguro médico)

Fill in the gaps: franquicia, reembolso, autorización, solicitud, copago, póliza

(Billing and refund notice (health insurance))

Para consultas privadas, revisa tu antes de pedir cita. Algunas pruebas necesitan previa y, si no la tienes, el seguro puede no cubrir el gasto. En la factura puede aparecer un o una : esa parte la paga el asegurado.

Si quieres , guarda el justificante médico y presenta la de reembolso en la app en un plazo de 30 días. Si falta un documento, el proveedor médico puede enviarlo por correo. Para dudas, consulta la cobertura y la lista de espera de la asistencia sanitaria pública.
For private consultations, review your policy before making an appointment. Some tests require prior authorization and, if you don’t have it, the insurance may not cover the expense. An invoice may show a copayment or a deductible: that part is paid by the insured.

If you want a refund, keep the medical certificate and submit the refund request in the app within 30 days. If a document is missing, the medical provider can send it by mail. If you have questions, check the coverage and the waiting list for public healthcare.

  1. ¿Qué debe hacer el asegurado antes de una prueba para evitar pagar más y qué documentos necesita para pedir el reembolso?

    (What should the insured do before a test to avoid paying more and what documents do they need to request the refund?)

Exercise 3: Listening

Instruction: Listen to the audio and answer the questions.

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(Yesterday I went to the doctor as a policyholder on my policy. The provider told me that the consultation is covered, but for the test I need prior authorization. If I don’t have it, I will pay the expense out of pocket. In public healthcare the waiting list is long, that’s why I prefer to use the policy. At reception they gave me a medical certificate. This afternoon I will submit the reimbursement claim because I already paid a small copayment.)
True False

(They need an authorization before having the test for the company to cover the expenses.)

(They prefer public healthcare because the waiting list there is short.)

(They already paid a copayment and that’s why they are going to request reimbursement.)

Exercise 4: Multiple Choice

Instruction: Choose the correct solution

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1. Mi póliza no ___ las gafas, así que pago el gasto de bolsillo.

(My policy doesn’t ___ glasses, so I pay the expense out of pocket.)

2. Para que me ___ el copago, presento la solicitud de reembolso en la web.

(So that they ___ my copay, I submit the reimbursement request on the website.)

3. Si necesito una autorización previa, ___ al proveedor médico antes de la prueba.

(If I need prior authorization, I ___ the medical provider before the test.)

Exercise 5: Dialogue Cards

Instruction: Practice the conversation with your teacher or fellow students.

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1

Reembolso tras consulta privada

Exercise 6: Discussion questions (QR: AI+)

Instruction: Speaking: translate and respond (QR: AI+)

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Useful expressions:

Según mi póliza, la cobertura incluye… / Normalmente pago de mi bolsillo… / Puedo presentar una solicitud de reembolso si es necesario.

  1. En España, ¿qué harías si el médico pide una autorización previa y tu póliza no lo deja claro?
    In Spain, what would you do if the doctor requests prior authorization and your policy doesn’t make it clear?

    __________________________________________________________________________________________________________

  2. Describe una situación en la que tuviste que pagar un copago o un deducible: ¿cuánto pagaste y recibiste algún reembolso?
    Describe a situation in which you had to pay a copay or a deductible: how much did you pay, and did you receive any reimbursement?

    __________________________________________________________________________________________________________

Exercise 7: Writing correspondence (QR: AI+)

Instruction: Write a reply to the following message appropriate to the situation

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Show translation

Asunto: Factura y seguro médico

Hola Marta,

Te escribimos desde Clínica Salud Norte. En tu última visita (15/06) realizamos 2 sesiones de fisioterapia. Según la información que tenemos, tu póliza no cubre el 100% y hay un copago de 12 € por sesión. Por eso, queda un pago de 24 €.

Si quieres pedir reembolso, podemos darte un justificante médico y la factura. Dinos también si tu aseguradora pide autorización previa.

Gracias,
Lucía Pérez
Administración

Subject: Invoice and health insurance

Hi Marta,

We’re writing to you from Clínica Salud Norte. At your last visit (15/06) we carried out 2 physiotherapy sessions. According to the information we have, your policy does not cover 100% and there is a copayment of €12 per session. Therefore, there is an outstanding payment of €24.

If you want to request reimbursement, we can provide you with a medical certificate and the invoice. Also tell us if your insurer requires prior authorization.

Thank you,
Lucía Pérez
Administration

Useful phrases:

  1. Quería confirmar si mi póliza cubre…

    (I wanted to confirm whether my policy covers…)

  2. ¿Me pueden enviar la factura y el justificante médico, por favor?

    (Could you send me the invoice and the medical certificate, please?)

  3. También necesito saber si hace falta autorización previa.

    (I also need to know if prior authorization is required.)

Hola Lucía:

Gracias por el mensaje. Quería confirmar el copago: ¿son 12 € por sesión, entonces 24 € en total? Por favor, ¿me pueden enviar la factura y el justificante médico para presentar la solicitud de reembolso a mi aseguradora?

No estoy segura si necesito autorización previa. ¿Aparece algo en su sistema o me recomiendan preguntar al seguro antes de pagar?

Muchas gracias,
Marta Gómez
Hi Lucía,

Thank you for the message. I wanted to confirm the copayment: is it €12 per session, so €24 in total? Please, could you send me the invoice and the medical certificate so I can submit the reimbursement request to my insurer?

I’m not sure whether I need prior authorization. Does anything show up in your system, or do you recommend that I ask the insurance company before paying?

Thank you very much,
Marta Gómez