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How not to get cheated while claiming health insurance?

IamCheated.com Research Team | July 04, 2019  7:04:pm

How not to get cheated while claiming health insurance?

As medical expenses rise each day, it is necessary to avail a health insurance plan. If you do not have health insurance, medical expenses can actually burn a hole in your pocket and stress finances. Simply availing a health insurance plan is just not enough. Instead, you must be careful, both while availing and claiming health insurance. In this blog, we discuss, how to be successful with the health insurance claim.

When it comes to claiming a health insurance plan, there are two types:

They are cashless and reimbursement claims. Let us discuss these claims.

1. Reimbursement Claims

In the case of reimbursement claims, you have to pay the hospital bills yourself and get the amounts reimbursed after discharge. You have to opt for reimbursement, if the hospital is not part of the insurer’s network hospital.

2. Cashless Claims

Insurers have tie-ups with hospitals and these hospitals are called network hospitals. If you get admitted to a network hospital, the insurer will settle the bill directly with the hospital and you don't have to pay anything out of pocket. It is quick and convenient when compared to reimbursement claims.

Raising health insurance claim

1. Make sure to maintain transparency

Make sure not to hide any critical information from the insurer. In case you hide anything from the insurer, your claim is likely to be rejected as this is insurance fraud. You have to reveal any existing medical condition. It is mandatory to fill both the insurance application and insurance claim form accurately.

2. Coverage and exclusions

Health insurance plan comes with its own coverage and exclusions. Different policies offer different coverage. Your claim will not be settled if your medical issue is not covered under your policy. To enjoy a smooth claim settlement process all the terms and conditions must be met.

3. Supporting documents

While filing your insurance claim, you must provide supporting documents along with the claim. These documents are a must for filing both offline and online forms. Here are the documents which must be submitted.

  • Insurers claim form, duly filled and signed by the policyholder
  • Discharge card
  • Consultation from the doctor along with receipts
  • Hospital bills stamped and signed by the hospital authorities
  • X-ray films and other test results like blood test, urine test and so on.
  • Medicine bills
  • Other pertinent documents relating to the cause of treatment.

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