punya kartu BPJS, kecelakaan lalu ditolak menggunakan manfaat kartu BPJS? ternyata begini solusinya

By | November 13, 2014

seorang teman kemarin bertanya pada sy bahwa dia punya kolega yg mengalami kecelakaan, kemudian korban kecelakaan di bawa ke UGD sebuah rumah sakit daerah setempat, setelah mendapatkan pertolongan perawatan pertama di UGD, keluarga pasien hendak mengurus administrasi karena harus opname, sebagai pemegang kartu BPJS, tentunya perawatan di RS Rujukan biayanya akan ditanggung oleh BPJS, tapi apa yg terjadi ternyata petugas di counter pendaftaran ‘menolak’ penggunaan fasilitas BPJS sehingga harus menggunakan fasilitas pembayaran mandiri/umum, krn memang BPJS tidak menanggung klaim biaya dari korban kecelakaan.

kebetulan sy punya teman yg memang pekerjaan sehariannya mengurusi soal pembayaran klaim BPJS, setelah bertanya ternyata benar BPJS tidak menanggung klaim korban kecelakaan meskipun itu pemegang kartu BPJS, TETAPI hal itu tidak sepenuhnya benar karena saat ini aturan yg berlaku adalah korban kecelakaan akan mendapatkan klaim asuransi kecelakaan/santunan biaya perawatan dari pihak Jasa Raharja, jadi biaya RS yng nanggung Jasa Raharja.

pihak Jasa Raharja akan menanggung biaya perawatan sampai maksimal 10jt rupiah utk kecelakaan angkutan darat dan laut sedangkan untuk kecelakaan angkutan udara sampai 25jt rupiah, dan apabila biaya RS melebihi dari plafon yg diberikan Jasa Raharja maka disinilah fungsi Kartu BPJS pasien yang akan nomboki kekurangan biaya perawatan tersebut, jadi misalnya korban kecelakaan biaya perawatan total 15jt rupiah maka nanti yg 10jt ditanggung oleh Jasa Raharja dan kelebihan 5 jt-nya ditanggung oleh BPJS.

salah syarat untuk mendapatkan klaim penggantian biaya dari jasa raharja adalah korban kecelakaan melaporkan kecelakaan yg menimpa kepada pihak kepolisian setempat/satlantas, nanti akan mendapatkan surat keterangan, kemudian surat ini dibawa ke RS dimana pasien itu dirawat, di beberapa RS tugas pasien selesai sampai disini krn nanti pihak RS yg akan meneruskan proses klaim ke Jasa Raharja tapi ada jg RS yg tidak menyediakan fasilitas seperti itu sehingga pasien/keluarga pasien yg diharuskan datang sendiri ke Jasa Raharja, sedangkan untuk berkas administrasi yg harus di bawa ke Jasa Raharja bisa ditanyakan ke pihak RS bersangkutan atau menghubungi informasi jasa raharja terdekat.

fyi, kecelakaan yg tercover asuransi kecelakaan Jasa Raharja bukan kecelakaan tunggal dgn kendaraan pribadi lho ya, jadi yg tercover adalah kecelakaan yg melibatkan 2 pihak atau lebih, untuk kecelakaan tunggal tercover Jasa Raharja selama kecelakaan itu terjadi saat berada didalam angkutan umum yg resmi dan berijin.

ada yg ingin menambahkan? cmiiw, koreksi jika sy salah 😀

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246 thoughts on “punya kartu BPJS, kecelakaan lalu ditolak menggunakan manfaat kartu BPJS? ternyata begini solusinya

  1. andhi_125

    kalo ndak punya SIM ?
    trus prosedur lanjutan bila ternyata, biaya diatas plafon yang dicover jasa raharja, ke bpjs-nya piye mas??

    Reply
  2. yunan

    Nice info, mas 🙂

    Btw, ikutan curhat…beberapa waktu lalu sodara ada yg kecelakaan dan dirawat karna patah tulang, pas mau urus jasa raharja diminta pengantar dari pak pol…
    Nah repotnya ngurus di pak polnya.. 🙁
    Sodara saya kebetulan kena tabrak lari, setelah kejadian memang keluarga ga kepikiran lapor polisi dan semua konsen mikirin mau dibawa berobat kemana biar ndang sehat…
    Eh, begitu besoknya lapor pak pol malah disalahke knapa ga langsung lapor polisi saat kejadian, jadi ga bisa dapet surat keterangan…solusinya dan diminta saksi untuk dapet surat keterangan tp akhirnya ga dapet saksi yg bisa tau kronologis kecelakaan dan ciri2 si penabraknya, maka surat keterangan urung di dapat..
    Bablas sudah surat keterangan dan jasa raharja..akhirnya ditalangin bareng keluarga buat biaya pengobatannya,
    Sedikit curhat aja, buat saya yg namanya kecelakaan ya pasti mikirnya ke rumah sakit sik bukan lapor pak pol sik… 🙁
    *padahal kecelakaan cuma beberapa puluh meter dr kantor polsek dan gak ada pak pol nongol katanya – mas jahe tau pasar kut*winangun nah disebelah timurnya 🙁

    Reply
    1. jahe Post author

      woooo ya begitulah 😀 tapi sebenarnya bisa ditanggung BPJS kok, ‘bilang’ saja jatuh sendiri *ifykwim

      Reply
    2. Yudha

      Pak Yunan, ikut prihatin atas kejadian yg menimpa saudaranya. Pd prinsipnya pengurusan klaim Jasa Raharja mudah.. sepanjang syarat dan ketentuan yg berlaku terpenuhi, maka klaim dapat ditindaklanjuti hingga pembayaran via transfer bank ke rekening korban atau ahli waris. Info lanjut silahkan hubungi call center 1500020 atau http://www.jasaraharja.co.id. Salam. #SiarJR

      Reply
  3. darsonogentawangi

    Kalau ndak punya SIM bisa pakai KTP pak bro…. Soalnya, aku juga pernah ngurusin adikku yg kecelakaan…. hehhe… BTW, nice info nich gan…. kayaknya pihak BPJS kudu banyak kasih informasi ke publik buat soal2 yg kayak beginian….

    Reply
  4. skalorman

    kalo misal lapor ke satlantasnya setelah korban dibawa ke RS gimana ya?
    misal korban ngga sadar, atau kecelakaan parah sehingga korban langsung di bawa ke RS, tanpa lapor ke satlantas, apakah masih bisa diproses BPJS nya? 😀

    Reply
    1. jahe Post author

      ya gpp ga harus pas kecelakaan, apalagi klo kecelakaane udah ditangani satlantas ‘otomatis’ surat itu nanti keluar 😀 cmiiw

      Reply
        1. El Zhar

          Bisa bang.. yg penting lapor segera kejadian kecelakaannya, jgn terlalu lama biar polisi nggak kesukitan olah tkp nya. Laporan polisi adalah dokumen pendukung utk santunan jasa raharja. Tks.

          Reply
    2. Yudha

      Mas Skalorman.. bila sudah lapor ke unit laka lantas polisi setempat.. selanjutnya dapat menghubungi petugas Jasa Raharja setempat (cabang/perwakilan/samsat) guna panduan selanjutnya. Bisa juga hub call center 1500020 atau http://www.jasaraharja.co.id. Salam. #SiarJR

      Reply
    1. jahe Post author

      jadi setelah kecelakaan, segera lapor ke jasa raharja terdekat selain ke pihak kepolisian,
      untuk urusan ganti biaya RS ya nunggu pasien dinyatakan sembuh oleh pihak RS dan keluar tagihan biaya2nyaa 😀

      cmiiw

      Reply
      1. El Zhar

        Om jahe, sekarang jasa raharja bisa terbitkan jaminan ke rumag sakit dimana korban kecelakaan dirawat. Jadi nanti biaya2 maks 10 jt langsung ditagih ke jasa raharja, korban tak oerly bayar lagi. Jika lebih dr 10 juta.. lebihnya ini yg ditanggung sendiri oleh korban atau bisa diklaimkan ke bpjs. Tks.

        Reply
  5. erna mirani

    Kalo kecelakaan tunggal apa tetep harus bawa surat keterangan jasa raharja?

    Reply
    1. Yudha

      Mbak Erna, bila kecelakaan tunggal, tidak perlu surat keterangan dari Jasa Raharja dan biaya yg keluar akan ditanggung oleh BPJS (sepanjang syarat dan ketentuan yg dikeluarkan oleh BPJS terpenuhi). Salam. #SiarJR

      Reply
  6. Alind

    Nahh,.
    Persis om, ini yg saya rasakan,.
    Tetapi ada kelalaian oleh pihak RS & saya harus membayarkan seluruh tagihan tersebut sampe butuh waktu 2hari buat “LUNAS”in *dikarenakan limit tarik tunai,.
    Bagian keuangan & admistrasi di RS ada miskomunikasi,. Surat yg telah diilayangkan oleh Jasa Raharja tidak diikut sertakan pada saat saya kekasir. Yg dmana seharusnya 10jt dicover oleh Jasa Raharja & kelebihan tagihan akan dibayarkan oleh BPJS,.
    Jasa Raharja akan reimbursement kan yg 10 *on process
    Yg selebihnya inii, kmana akan saya klaimkan?
    Apakah ke BPJS? Yg sgala biaya perawatannya telah saya bayarkan?
    Ataukah ke RS yg bag keuangan & admistrasi yg lalai?
    Gmana cara cairin dana pribadi yg telah terpakai tersebut?
    Dan obat”an yg jg pake dana pribadi, apa bisa dicairkan?
    Solusinya donk om,.

    Reply
    1. El Zhar

      Alind.. sharing pengalaman.. jika biaya rawatan dibayar sendiri oleh korban kecelakaan atau keluarganya, biaya2 itu masih bisa di klaimkan ke jasa raharja, maks 10 juta atau sebesar kuitansi. Tp tetap harus ada laporan polisi dulu. Mengenai sisanya jika lebih dr 10 juta.. bisa tanya ke bpjs dimana kita tinggal. Coba hub 1500020 contact center jasa raharja soal syarat ketentuan. Tks

      Reply
  7. El Zhar

    Mas Ahmad, ikut prihatin atas kecelakaan yg menimpa org tuanya.. sharing info memang benar syarat santunan dr jasa raharja (jr) harus ada laporan polisi. Jika terbit, maksimal 10 juta biaya rawatan yg ditanggung jr, jika ada lebihnya akan ditanggung bpjs kalau korban adalah anggota bpjs. Melihat kasus ini, saran saya tetap saja ajukan laporan hingga terbit lp krn itu hak korban, kecuali penabrak sanggup bayar. Jika nggak sanggup.. disinilah fungsi asuransi jasa raharja yg dibayar setiap tahun lewat perpanjangan pajak stnk oleh pemilik kendaraan. Kalo penabrak nggak mampu keuangannya, maka dialihkan tuntutan keuangannya ke jr, dgn syarat dan ketentuan berlaku. Saran soal masalah disidang.. setelah laporan polisi terbit, coba saja ajukan damai, intinya keluarga korban tidak menuntut penabrak. Siapa tahu dimungkinkan utk tidak dilanjutkan oleh pihak kepolisian. Yg penting, bagaimana caranya laporan polisi bisa terbit sehingga bisa ajukan klaim ke jasa raharja. Demikian sharingnya mas.. smg ada jalan keluar. Tks.

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