Categorized | Health Insurance

how to claim health insurance?

In today’s world one cannot think about staying without health insurance. Just like any other insurance which guards the person's finances similarly Health Insurance guards expenses which go towards medical reasons.

There are two kinds of claims in regards to health insurance:

1.Reimbursement claim

In case the hospital in which the treatment is being conducted is not in the network list of the insurance Policy then the Policyholder is entitled to get the Reimbursement for the expenses incurred in treatment upon submission of required documents duly completed and signed.

In order to go in for reimbursement of claims one must first and foremost inform the insurer. If there happens to be an emergency then it is required that the person informs the Insurer before 24 hours of hospitalization.

Following tips must be kept in mind in order to have a smooth flow of reimbursement:

•It is important to keep all the prescriptions and file them as they are useful while filing for reimbursement. Some health insurance policies also cover recipients of medicine and other expenses hence it is advisable to retain the bills and invoices.

•Remember to keep multiple copies of discharge card, bills and details of medicine as they may be required to be filled at more than one place.

•The Claim form needs to be filled and attached with all the required documents.

•Make sure that the documents reach the right address in case of speed post or courier. Remember to ask for a receipt as there is a time limit for sending the documents in order to get reimbursement.

2.Cashless Claims

In case of Cashless Hospitalization the policyholder is entitled for a free of cost treatment in case of hospitalization. The pre-requisite for the cashless claim is that this facility can only be obtained by the hospital in which the treatment is being conducted is registered under the panel of the insurance company.

Types of Cashless Claims:

1.Planned Hospitalization

In case of planned Hospitalization one must inform the insurance company beforehand around 2-3 days before hospitalization.

•After you have informed the insurance company about hospitalization, then they will provide you a claim initiation number.

•Now the policyholder needs to fill in the pre-authorization form which mentions the required treatment needed and the cost which would be incurred.

•Once this form is submitted, the  TPA will go through the form and provides an authority letter which would state that the treatment would go cashless.

•Submit all the required forms and paperwork to the hospital and the hospital will submit the forms to the insurance company.

2.Hospitalization in case of emergency

If your hospital is in the panel then you can go in for cashless treatment otherwise you can apply for reimbursement of expenses after the treatment is over. If you wish to go the cashless way then keep in mind that the policyholder has to take a prior approval from the insurance company. In case of emergency the hospital tends to speed up the process keeping in mind the ailment.

How to avoid rejections in medical claim

1.Your claim might get rejected if the hospital in which you have been treated is not in the insurance company’s network.

2.In order to avoid confusion, in case you have more than one health insurance then clearly mention which one you want to make use of.
3.Submit all the required and completed paperwork along with completed claim form.

4.Make sure of getting a prescription  in writing from the doctor stating admission in case of an emergency.