A health insurance claim or a medical insurance claim is a request that is raised by the policyholder for compensation of the expenses incurred for the treatment. The insurance company upon verification of the claim either settles the bills directly with the hospital or reimburses the amount you spend, depending on the type ofclaim procedure you have opted for.
Types of Health Insurance Claim:
The primary objective of a health insurance policy is to provide financial assistance when required. To get the reimbursement on time from the insurance company, one has to avail either of the two services below:
Cashless procedure for Planned Admission:
- Choose a hospital from the network as mentioned in the insurance document.
- Inform third-party administrator (TPA) 3 days prior to admission & provide a membership number.
- Fill cashless request form at the hospital.
- Submit the form and medical records to TPA.
- TPA will inspect all the documents.
- Once approved, the insurance company will settle the hospital bills, which excludes phone charges, attendant charges, food etc.
Cashless procedure for Emergency Admission:
- In case of emergency admission, inform third party administrator (TPA) & provide a membership number.
- Fill the cashless format the hospital, certified by a doctor.
- Send the form along with medical records to TPA.
- If a cashless facility is sanctioned, hospital bills will be settled directly.
- Seek reimbursement in case of disapproval
Reimbursement –
In a reimbursement claim, you must initially pay for the treatment and then file a claim for reimbursement. When you file a claim, you must produce the bills and showcase other records of the money spent on hospitalisation and treatment. The insurance company, after verifying the bills, will credit the amount to your bank account.
Reimbursement procedure for a claim:
- Get in touch with your insurance company through the toll-free number & provide a membership number.
- Settle all the hospital bills.
- Present the bills, prescriptions, discharge summary and other necessary documents when you request for reimbursement.
- Download & fill the reimbursement form, available on the insurance website.
- Submit the form along with medical records to the insurance company.
- A cheque will be disbursed once the claim is approved. The general turnaround time for the process is 20 days from the date of receipt of all documents
Important Points To Remember For Claims:
- The forms for reimbursement must be filled correctly, if not, then the claim request might be denied.
- Claim request must be raised within 7 days of discharge.
- The non-payable items will be not reimbursed by the insurance company.
