Master the health insurance claim process to avoid financial stress during medical emergencies!
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While it does not have to be, the intricacies of filing health insurance claims can be daunting. Selecting an insurance plan that allows you to file claims with ease is crucial. It leaves you with peace of mind to focus on what truly matters—your health and well-being.
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When filing for a claim, the first thing you need to do is inform the insurer at the earliest. You need to adhere to the timeframe specified by the insurance company in the policy documents. If you fail to inform them on time, they will reject your health insurance claim.
You can opt for cashless or reimbursement claims based on your requirements. In a cashless claim, your insurance provider settles the bill directly with the concerned hospital. However, you can opt for this facility only if you get hospitalised at a hospital included in the list of the insurer’s network chain.
Opting for a reimbursement claim requires you to pay hospitalisation charges upfront at the time of discharge. You can reimburse these costs later by submitting original documents to the insurer. However, you can opt for reimbursement claims at non-network or network hospitals.
You can file for claims on your medical insurance policy through two different methods. Here are the two types.
Cashless Treatment
You can only get this facility at network hospitals included in your health insurance plan. Follow these steps to complete the health insurance claim process.
Take admission into a network hospital and inform the insurance company
The hospital staff will share a claim form, pre-authorisation form, and necessary documents with the insurer
The insurer will approve your claims if they are within your policy’s terms and conditions
Claims on Reimbursement Basis
This facility enables you to get treatment at any of your preferred hospitals. Here are the steps that you need to follow.
Inform your insurer 72 hours before taking admission or 48 hours in instances of emergency admission
Submit relevant documents like hospital bills and doctor’s prescriptions to the insurer
After verifying your claim, the insurer will reimburse the amount within 10-15 business days
Note: The time taken for processing these claims can vary based on your plan and the insurer’s approval process. Kindly check these details well in advance with your insurer before getting a health insurance plan.
The paperwork you need to submit can vary depending on the process you opt for and the insurer’s policies. The following are some of the basic documents you need to submit.
Filled claim form available on the insurer’s website and the hospital’s insurance desk
Medical bills, doctor’s prescriptions, discharge summary, and other medical reports
Proof of identity, such as an Aadhaar card, passport, voter ID, and any other government-issued ID card
Your policy can offer valuable financial support during medical emergencies. But a smooth health insurance claim process hinges on understanding key factors, which include:
Make a Claim Within the Specified Time
Inform the insurer about hospitalisation within the given timeframe to avoid any rejections.
Provide Accurate Details
Ensure that you are providing the correct information and attaching the right documents.
Utilise Cashless Facility
Opt for a cashless claim process, as the network hospital will manage the claim settlement.
Ensure Adequate Coverage
Ensure that your policy offers enough coverage for the expenses incurred on medical treatment.
A smooth claim settlement process saves you from financial stress during medical emergencies. Here are a few strategies to avoid your health insurance claim getting rejected:
Pay your policy premiums on time to ensure that it remains active
Disclose your medical history and pre-existing conditions in the health insurance proposal form
Carefully understand the policy’s terms and conditions and strictly adhere to them
Before undergoing a treatment, ensure that you take pre-authorisation from the insurer
After filing the claim, you may have to wait a few days to receive reimbursement. Follow these methods to check the status of your health insurance claim.
Online: Most insurance companies allow you to check the status on their website
Call: You can also get in contact with the insurer’s customer support team to know its status
- Visit the Branch: You can know about its status offline by visiting the insurance company’s branch
FAQs on Health Insurance Claims
What will happen if I file a medical insurance claim under a policy that has expired?
If you file a claim under a health insurance policy that is no longer valid, your insurer will reject the claim. Renew your health insurance plan on time to benefit from coverage.
How to claim health insurance?
You can claim health insurance in two ways: cashless and reimbursement mode. Under cashless claims, you do not have to pay medical bills upfront. Under reimbursement claims, you pay for health expenses yourself and later file to be reimbursed.
What are the two types of health insurance claims?
Cashless claims and reimbursement claims are two types of health insurance claims. In a cashless claim, you will not have to pay for medical expenses yourself. The insurer will directly settle the bills with the network hospital.
In a reimbursement claim, you pay the medical expenses yourself and then file a claim with your insurer by providing necessary evidence. The insurance company credits the amount to your account after verification.
What are the documents required to file a health insurance claim?
The documents that you need while filing a health insurance claim include age proof, address proof, identity proof and claim form. You also need to provide medical reports, discharge summary, cancelled cheques and payment receipts, among other documents. The specific list depends on the type of claim you are filing and the insurer’s policies.
How much time does it take for a cashless and reimbursement claim to be settled?
While the timeline depends on the insurer, a cashless claim may be settled by a health insurance company in just three hours. An insurer may settle a reimbursement medical claim in about 20 days.
