Categorized | Health Insurance

documentation for health insurance and claims

You acted responsibly by purchasing a Health Insurance policy, but this is not where the responsibility ends. The benefit of the health insurance Policy can be realized only if you are able to successfully make a Claim in case of hospitalization. To ensure you are able to get appropriate claim from your health insurance provider, it is important that you are fully aware of the terms and conditions of the policy and rules for making a claim.

So when you sign a health insurance policy, ask your insurance advisor to explain you the terms of the policy regarding claims processing. Read the policy document carefully and ask your advisor to explain you the concepts you are not able to completely understand..

Your Mediclaim form must include all relevant OPD expenses upto 30 days prior to your admission in hospital. To get a claim for post-hospitalization expenses, all relevant expenses upto 60 days from your hospital discharge should be submitted along with relevant bills within 90 days from your date of hospital discharge. Please be aware, you MUST submit Reimbursement claims within 30 days from the date of discharge from Hospital.

As you would need to submit original documents, keep them safely, also save a copy for your reference. To make a hassle-free claims processing, you need to save following documents carefully:

1.Discharge Card

This is a very crucial piece of documentation which contains basic details such as date of admission, date of discharge, condition of the patient when hospitalized and a short note on diagnosis and treatment administered to the patient besides the advice of the doctor on discharge.

2.Letter of First Consultation and advice for hospitalization 

Insist your doctor to give you a letter of the first consultation in writing on his letterhead. This letter informs the reason for your hospitalization, treatment desirable for your medical condition and whether you need to undergo any surgery. Make sure the letter is dated correctly.

3.Duly stamped and signed hospital bills with receipts 

Get detailed bills from the hospital and make sure the bills are duly stamped and signed by the hospital authorities. Make sure that hospital’s registration number is mentioned in the bill.

4.Medicine Bills along with doctor’s prescriptions

Remember to save all the medicine bills. Make sure the bill states the patient’s name correctly and bears the date. When submitted along with doctor’s prescription, your claim gets more authenticity.

5.Test reports, bill receipts along with doctor’s letter for all tests performed

You need to submit bills related to all medical tests that you undergo for your treatment. These bills should be supplemented with doctor’s letter and receipt from the test centre. Keep X-ray films ready, as sometimes TPA may ask for those.

6.Consultation receipts

Likewise, you also need to save consultation receipts. So, it is advisable that you insist on getting a consultation receipts every time you visit a doctor.

7.Documents pertaining to your specific condition

In addition to the above documents, you may need to submit documents pertaining to your special conditions along with your mediclaim forms. These documents will help to give more authenticity to your claim and help you get your due claim. For instance, if you were hospitalized because of a road accident, you may need to provide a copy of the FIR describing the incidence.

8.Duly filled and signed claim form

Along with the above mentioned documents, you would need to submit a completely filled up and signed claim form. If you personally submit the claim form, collect a signed receipt for the same.
 
Please note that this list mentions the most important documentation requirement for claims settlement but is not an exhaustive one. Your TPA may ask for more documents relevant to your condition. Keep all Hospitalization and related documents carefully.