How to Make a Health Insurance Claim?


Health insurance is not a choice, but it has become a need of time. One must have own medical insurance for financial security at a times of unfortunate medical emergency. Thanks to this age of digitalisation, buying a health insurance policy is now just a work of your fingertips. Many prominent insurance companies have amazing digital presence. They are offering health insurances online saving hours from the busy schedule of buyers. They can read and study the policies on websites and decide on their own.
Just buying health insurance has simplified, making its claim has also streamlined by insurance companies. This article will help you understand how to make a health insurance claim.
The first thing you need to understand about claim settlements is their two types, reimbursement and cashless. You must be knowing the type of claim you have on your policy. If not, read the policy document or contact your insurer to know about them.
Claim to cashless transaction during hospitalisation
The Health Insurance Claims for cashless settlements save from managing the cash at the time of hospitalisation. For cashless claim settlements, you need to check-
  1. Whether the hospital you are at falls under the network of your insurance company.
  2. Whether the reason for hospitalisation is subjected to cashless claim.
The first thing you need to do while claiming a cashless transaction during hospitalisation is intimating your insurer about the claim. The hospitals under the network of your insurer has Third Party Counter (TPA) for clam settlements. During admission of the patient, the accounts department of hospital asks you to submit Pre-Authorisation Form at TPA counter.
In addition, you will need to submit the Cashless Health Card and some KYC documents at TPA Counter for the approval.
Once the insurer confirms the claim, the hospital keeps the related documents for their records. Thus, keep a copy for the everything for your reference.
If your health insurance is covering your post-hospital expenses, you need to keep all bills and prescription to make a claim. This claim works on reimbursement basis.
Claim to reimburse after hospitalisation
Some health insurances have reimbursement provision in them, which means you get paid all the expenses after claiming. In other words, you need to pay all the bills during hospitalisation and later the insurer re-pays accordingly.
Also, admission in the hospital which is not under insurer’s network may subject you to reimbursement of the expenditure.
For reimbursement, inform your insurance by submitting claim form within 30 days from discharge. Attach all the stamped bills of treatment, diagnosis and medicine along with the claim form. The most important document to submit is hospital bill which must possess the registration number of the hospital on it. Submit doctor’s prescriptions also which will clarify that whatever medicines and diagnosis the patient has gone through is by doctor’s advice, not voluntary.
After claiming, retain keep copies of everything for your record. The Health Insurance Claims for reimbursement are generally settled within 2-3 weeks after filling it.

How to Make a Health Insurance Claim? How to Make a Health Insurance Claim? Reviewed by Sahil Arora on March 19, 2019 Rating: 5

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