Health Insurance

Every Insurance Company has laid down few procedures to enable hassle-free claim process. Hence, it’s important to be aware of these processes to avoid any surprises. There are two ways to claim Health Insurance, and they are :

  1. Cashless Settlement

Insurance companies have a network of hospitals that form a part of their Preferred Provider Network. Treatment in any of such hospitals entitles you for a cashless treatment where the insurance company settles the cost of hospitalization directly with the hospital without your intervention.

Settlement

  1. Reimbursement of Medical Expenses

In case you are unable to get treatment at any of the hospitals within this network you can opt for hospitalization and treatment in the hospital of your choice and pay through your pocket and then claim for reimbursement. Considering the high costs involved, this is usually not the most preferred choice for most people.

The following are the steps involved in each of these methods –

  1. Cashless Settlement

  • If it’s a planned hospitalization, intimate the insurance company 1-2 days before hospitalization. In case of an emergency, the time period is anytime within 24 hours of admission.

  • Network hospitals have an organized and systematic helpdesk to assist the insurers with all things concerning the required documents and formalities. Therefore, it is necessary to contact the help desk to fill the claim form and submit the required documents.

  • On receiving the documents, the Insurance Company will run a check and identify the costs that can and cannot be covered under the terms and conditions of the Insurance. If the case is within the coverage scope, the Insurance Company sends an approval to the hospital for the specified amount. Should the cost exceed the amount approved, the hospital may request for a pre-approval.

  • If due to any reason the request for a cashless treatment is denied, one can settle the bill on his own and then raise the request for reimbursement.

  1. Reimbursement

  • Intimation to the insurance company in case of hospitalization, both planned and emergency holds good for reimbursement of claims as well.

  • Post-hospitalization and treatment, one is required to present the below-mentioned documents for further processing of the request.

  • A filled claim form

  • A Discharge certificate signed by the treating doctor

  • All the medical receipts along with the prescriptions

  • Copy of the cheque that was declined

  • Any other necessary documents as per the request of the insurance company

  • The insurance company will then scrutinize the documents submitted and accordingly either accept or reject the claim based on the policy terms and conditions.

  • An accepted claim will present the final amount that is disbursed with the Claim Settlement Letter specifying the amount break-ups.

  • In case the claim is rejected, a Claim Rejection Letter will be sent to the insured stating the reasons for the same.