Categorized | Health Insurance

claiming mediclaim insurance in india

When you buy  Mediclaim insurance policy, you breathe a sigh of relief knowing that you will now be able to afford the best healthcare solution for any disease that may afflict you or your family member. But an important point to remember here is that just buying a mediclaim insurance Policy is not enough, you also need to take care that you manage the claims procedure well enough.

With regard to claiming mediclaim insurance, the various aspects that you may need to be mindful about include:

1) Opt for Hospitalization or treatment only when medically required

While consulting with hospitals for a given medical condition that may be troubling you or any of your family member, beware of hospitals which may advise for a treatment that is not medically warranted. There may be a few private hospitals which in order to drive higher revenues from their business, may be unnecessarily treating you. Hence, before undergoing hospitalization, it is advisable that you ensure that you have received sound medical advice otherwise you run the Risk of your Claim being rejected by the insurer.

2) Choose the right hospital for your treatment

A few private hospitals in their wild chase for money have opted for unfair practices like over invoicing or inflating the bills. As a result, insurers on an ongoing basis keep removing such hospitals from their panel. Also make sure that the hospital where you are seeking treatment has a valid registration certificate. There have been a few cases, wherein the claim for mediclaim insurance has been rejected as the hospital did not hold registration certificate.

3) A prior approval from the Insurer will always ease the claims procedure

If it is not an emergency treatment, it is preferable that before undertaking a treatment for a medical condition you seek advice from your insurer if the medical condition for which you are seeking treatment is covered or not.

4) Be mindful of the expenses that are incurred

It is important that you be watchful of the expenses that you make at the hospital. While you are taking a discharge, vet the bills that have been levied before signing on them. Try to make sure that whatever is billed has also been administered to the patient. Also, negotiate with the hospitals regarding potential rates and ensure that these are in line with the market rates. In nutshell, it would be wise that you contemplate expenses as if these are to be made out of pocket, so as not to be shocked later by a rejection.

5) If the claim is rejected, ask for a written reply


If you have a genuine case and still your claim is rejected, please do not feel disappointed. Ask the insurer to submit to you a written reply which confirms the reason on why the claim has been rejected. Once you have this with you, you can appeal to a consumer forum or any court of justice.