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How To Claim Health Insurance?

IamCheated.com Research Team | December 28, 2018  4:32:pm

It is well known that not having a health insurance plan can burn a hole in your pocket as medical expenses rise. Now, many people have understood the importance of health insurance and they are coming forward to avail these plans to meet unexpected medical expenses. If you have a health insurance plan, your medical expenses will be taken care of by the insurer and you will enjoy peace of mind.

If you have already availed a health insurance plan, the one thing that must be worrying you is claim settlement. Many people are not aware on the claim settlement procedures. In this blog, we will discuss how to make a health insurance claim.

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How To Claim Health Insurance?

Types of claim settlement under the health insurance plan:

  • Cashless Claims

  • Reimbursement claims

1. Cashless Claims

In case of a cashless facility, if you get admitted to the network hospital, you don't have to pay the hospital bills. Instead, the Insurance Company represented by the Third Party Administrator (TPA), co-ordinates with the hospital and pays the bills on your behalf.

  • Before availing cashless hospitalization, it is very important to check two things. The first thing you must check is whether the hospital you plan to get admitted is a network hospital. The second thing is whether the disease is covered as per the Terms and Conditions of your health insurance plan.

  • If the hospital is in the list of network hospitals, the next thing you must do is inform the insurer that you are availing the cashless facility. During hospital admission, you will be asked if you are opting for cashless or reimbursement. You will have to fill a Pre-Authorization Form and submit it at the TPA (Third Party Administration) counter. The form will be forwarded to the insurer for the cashless approval.

  • Along with the Pre-Authorization form, you are also required to submit documents like Cashless Health Card provided by your insurer and KYC documents for identity purpose.

  • As soon as the cashless claim is approved by the insurer, it will keep all your documents vis-a-vis hospitalization. So, it is better to ask for a copy of the same for further reference.

See Also: How to choose the best Term Insurance Plan?

2. Reimbursement claims

Not every insurer offers cashless facility and in such cases, you need to get hospital expenses reimbursed. You can also apply for reimbursement in the cases where you have taken treatment in a non-network hospital or if you fail to opt for cashless settlement. This is how you can claim reimbursement:

  • To claim reimbursement, the first thing you must do is inform your insurance company and submit the duly filled reimbursement claim form. You have to do this within 30 days from the date of discharge from the hospital.

  • Along with the claim form, you must attach copies of all the medical reports, medical bills and hospital bills duly stamped and signed. The name of the patient and the date should be clearly mentioned in the report. The hospital bill must mention the Registration Number of the hospital. You must also mention the prognosis prescription of your doctor who advised on the hospitalization. This is done to show that the hospitalization was not voluntary.

  • Once you are discharged from the hospital, you will be given the Discharge Summary. This says you are fit to be discharged. You must submit it to the insurance company.

  • For future reference, it is advisable to keep a copy of all the submitted documents. You will receive reimbursement within 2-3 weeks after you register for the claim.

See Also: How To Choose The Best Health Insurance Policy?

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