How to make Health Insurance Claim Easely

Currently Health Insurance policies are being sold as Mediclaim policy that means the insurance company will provide/ settle the claim for the policyholder during hospitalization through the cashless mode. Although reimbursement mode is also available.
Many health insurance companies provide cashless facility for its policyholder, but it can be used only on its network hospital, other hospitals do not offer the cashless hospitalization facility. In such cases, the policyholder needs to pay the dues to hospital and get the expenses reimbursed by submitting a claim to the insurer. So before purchasing health insurance the policyholder should be read companies guidelines in terms of network hospital.

Here is how to claim:

Intimate to your insurer

If you are going to be admitted to a network hospital due to some illness, it is your responsibility as an insured to inform your insurance company about the claim. However, in case of emergency hospitalization, the insurer or third-party administrator (TPA) should be informed of the upcoming claim within 24 hours.

Documents needed

If you are treated in a hospital where you have to pay out of your pocket, then it is important for you to collect all the necessary documents before leaving the hospital – like discharge summary, bills, prescriptions, copy of investigation reports, and pharmacy receipts.

Fill the Forms

To file a claim, the policyholder needs to fill up the prescribed reimbursement claim forms. Note that, some sections of the reimbursement forms also need to be filled by the hospital and signed by the doctor who treated the patient. Hence, get them ready before filing the claim. The claim form can be downloaded from the TPA/insurance company’s website.

Submit the claim

When submitting the claim form after leaving the hospital, additional documents such as discharge summary, the medical bill, a copy of the policy and the investigative report are required to be submitted to the insurer. pay attention That is, the claim must be submitted immediately after the policyholder’s discharge. To get paid on time, you should take help from your personal advisor.

Provide your Bank Details

To get timely payment, it is mandatory for policy holders to submit their bank information while submitting the claim form.
Policyholder’s bank account details, with IFSC code. Additionally, there may be a cancelled check or attested bank account containing the account information. Need to be submitted by the policy holder so that the claim can be reimbursed.

Procedure

On receipt of papers and documents and while scrutiny, the insurance company/TPA might call for additional documents for processing the claim. The policyholder needs to submit those
documents to avoid rejection of the claim. Keep in mind to retain old health insurance papers, as at times copies of old insurance papers might also be required when making reimbursement claims. Always be honest.

Comments

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