Guide to Filing for Your Health Insurance Claim

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Guide to Filing for Your Health Insurance Claim

A health insurance claim refers to a request that the policyholder of a health insurance plan submits to the insurance provider to receive the services covered under the plan. Here’s everything you need to know about types of medical insurance claims and how to file them.

Kinds of Health Insurance Claim

You can make a health insurance claim whenever you want the insurance company to settle an eligible medical expense you’ve incurred. Here are 2 ways to claim a health insurance plan.

Cashless Claim: In this case, the health insurance company in India settles the hospitalisation bills directly with the hospital. But you need to be hospitalised only at a hospital in the insurance provider’s network.

Reimbursement Claim: In this case, you must make an upfront payment of the hospitalisation costs and request the insurance company for reimbursement later at non-network or network hospitals.

How to Settle Cashless Medical Claims or Reimbursement Claims?

You can avail a cashless or reimbursement claim for a health insurance plan with the following steps:

  • • Visit the insurance help desk at the hospital.
    • Produce your ID card provided by the health insurance company to verify your identity as an insured.
    • You also need to mail or fax the required documents like original investigative reports, prescription receipts, discharge summaries and hospitalisation bills to the health insurance company.
    • After verification, the hospital will submit the pre-authorisation form to your insurance provider.
    • The insurance company will go through all the submitted documents to process your claim abiding by the terms and conditions of the health insurance plan.
    • A field doctor may be assigned to make the hospitalisation procedure simpler for you.
    • After all the formalities are done, your insurance provider will settle your claim if it meets the policy’s terms.

Remember that a medical insurance cashless claim can be of the following two kinds:

Planned Hospitalization: It means you’re already aware of your hospitalisation.

In this case, you can claim a cashless treatment using these steps:

• Dial the toll-free helpline number of the health insurance company in India beforehand.
• Fax the pre-authorisation form to the fax number of the insurance company. Before this, ensure that the hospital has duly filled the form.

Emergency Hospitalization: This means you require immediate hospitalisation due to suffering from any illness or having met with an accident.

In this case, take the following steps to claim a cashless treatment:

• Your family must contact the insurance company on its toll-free number after admitting you to the hospital.
• The duly filled pre-authorisation form must be faxed to the fax number of the insurance company within 24 hours of your hospitalisation.

You can usually find the fax and toll-free helpline numbers on your insurance ID card or documents of your health insurance plan. Save them on your phone and share them with your family members so that they have quick access during emergencies.

The Authorization Procedure for Health Insurance Claims

As soon as your health insurance provider is intimated by the attendant of your claim and contacted by the hospital in this matter, the company verifies the validity of the health insurance plan and its coverage for you. Next, the insurer may assign a field doctor to verify the pre-authorisation document and cross-check the claimed medical procedure. After this, the medical team of the insurer approves your cashless claim if it satisfies the terms and conditions of the health plan.

Make sure to remember a few things when claiming the coverage of a health insurance plan. The authorisation request will be accepted only if all the details on the form are filled in correctly. A claim should be filed within 30 days from the date of your hospital discharge. You need to pay for any non-payable items on your own. It’s mandatory to submit all the necessary documents within 30 days from the date of your discharge to claim the total post-hospitalisation costs. Keep in mind these things when filing a claim and you’re good to go to receive the coverage benefits!


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