After more than two months of official operation, FV’s Social Insurance Department has become the central coordinator of a complex, multi-layered process involving state regulations, internationally standardised medical data, and cross-departmental collaboration. Every day, the team translates state Social Health Insurance regulations into clear, practical guidelines that shorten waiting times and, most importantly, ensure patients receive their rightful benefits, fully and accurately.

A Bridge Between International-Standard Care and Social Health Insurance Benefits

Ms Dao Thi Ngoc Bich, Head of Insurance Services, shared: “Our key responsibility is to transform the benefits written on paper into tangible advantages for patients, in a transparent, disciplined, and standardised manner.” Initial results show that efforts to expand the application of Social Health Insurance have improved patient access to FV’s medical services. In the first two months, FV recorded over 7,300 patient visits with Social Health Insurance declared, of which approximately 2,700 cases had Social Health Insurance applied. The total benefits granted to eligible patients are estimated at VND 4.3 billion.

Ms Bich also noted that Social Health Insurance benefits are most frequently used in departments with high treatment intensity and extensive diagnostic services, such as Oncology, and for chronic diseases or patients requiring specialised treatment. High utilisation is also seen in Cardiology, interventional procedures, eye surgeries, and eligible emergency cases.

Ms Ngoc Bich commends the dedication of the Insurance Services Department

To help patients maximise their benefits, the Social Health Insurance team at FV Hospital prioritises three elements: clear information, transparent costs, and friendly, professional service. The outpatient Social Health Insurance process at FV follows these core steps: Registration; Benefit Verification; Co-payment and Documentation Consultation; Coordination of Clinical Information; Social Health Insurance Benefit Confirmation; and Completion of Social Health Insurance Payment Procedures.

Professional Operations Ensure Accuracy and Compliance

The Social Health Insurance process is managed by two closely linked units: the Social Health Insurance medical secretaries, who prepare the records, and the claims verification team, who confirm Social Health Insurance benefits and reconcile data with the Social Insurance portal. “Close coordination between the two teams helps patients better understand their entitlements while significantly reducing waiting times for insurance confirmation,” shared Ms Le Phan Thu Hang, Social Insurance Medical Secretary.

Ms Le Phan Thu Hang explains to patients how Social Health Insurance is applied at FV.

In practice, common situations are handled by Social Health Insurance officers according to clear procedures. Examples include when a Social Health Insurance card cannot be found in the system using the national ID, the card has expired, the patient’s primary care provider is not FV, referral issues arise, or checks are needed against the list of serious illnesses in Appendix 2. In each case, officers at the counter address the issue clearly, provide detailed explanations and propose an appropriate, professional solution.

Ms Lam Thi Anh Minh, Social Insurance Officer, says patients often ask about FV’s insurance coverage limits or request an estimate of how much Social Health Insurance will cover for a specific treatment. “Overall, patients are satisfied with the information the hospital provides. We always use simple language and explain everything carefully, ensuring that patients, especially older patients, fully understand their insurance entitlements,” Anh Minh added.

Delivering Comprehensive Patient Service

The biggest operational challenge at present is accurately converting the hospital’s data for the Social Insurance portal while complying with Social Insurance regulations. The Social Health Insurance team must work across two systems simultaneously: Orion (English, JCI-standard) and SIWEB (Vietnamese, Social Insurance portal).

Thu Hang explains: “Our task is to update accurate and complete medical information for each patient case that is eligible for Social Health Insurance on the Social Insurance portal as required. This includes translating and transferring information from doctors’ orders and reports in Orion, or from nursing forms, into SIWEB.” Correct mapping of data fields between the two reference systems requires discipline and error control at every step to prevent mistakes that could affect patients’ entitlements and to ensure strict compliance with Social Insurance regulations.

Anh Minh (left) emphasises that close teamwork ensures no patient benefits are overlooked.

For cases requiring clarification in doctors’ reports, officers promptly contact the physician for timely updates or corrections in line with regulations. They then carefully review, verify, and reconcile any discrepancies in how medical records are documented, ensuring strict compliance with the Social Insurance framework before uploading the information to the insurance portal. As the officers observe, when medical reports are complete and clearly written, the time needed to process each Social Health Insurance case is significantly reduced.

From both professional and regulatory perspectives, Social Health Insurance is more complex to manage than commercial insurance due to its broader scope, numerous exclusions and overlapping procedures. According to Ms Bich, the successful implementation of Social Health Insurance across all outpatient departments in such a short period represents a major effort and an important milestone. However, sustaining this progress requires managing a team of over 40 staff members with an ever-increasing workload, which is a considerable challenge.

“This requires coordination and support from the entire hospital. We are also working towards continuously improving our processes, integrating technology and training staff to minimise errors and enhance efficiency,” Ms Bich shared.

Implementing Social Health Insurance across all outpatient departments marks a major milestone for FV

In preparation for applying Social Health Insurance to all treatment services at FV Hospital by early 2026, the Social Health Insurance Office is currently standardising inpatient documentation, mapping out potential scenarios during long-term hospitalisation under Social Health Insurance, and collaborating with technology providers to develop a simplified, optimised processing system. The ultimate goal is to deliver comprehensive, accessible care for patients while reducing waiting time and ensuring accurate benefit payments in compliance with Social Insurance regulations.

Growing patient satisfaction and cooperation since FV introduced Social Health Insurance is a positive sign, reflecting the hospital’s right direction and the dedicated efforts of the Social Health Insurance Office. Going forward, this new department will continue to be a strong, reliable support arm, helping patients optimise their treatment costs more easily at FV.