of medical bills is a tricky business that needs a lot of caution and care. However, being pre-informed about the process and having a systematic approach to things can make things simpler and easier.
This article attempts to keep you informed about things you ought to take care of for successful Health Insurance Claim
processing.When you can claim medical reimbursement
You can file a medical reimbursement claim with your insurance provider in case you have met with a medical emergency or if your doctor advises Hospitalization
to help you get cured of a disease. Before filing for medical reimbursement check whether or not the diseases for which you are filing claim are reimbursable according to the terms of your policy. Contact your TPA for more details regarding your decision to get reimbursement claim and formalities that are required to be completed to get the health insurance claim processing done successfully. Mentioned below are some general tips you must keep in mind when filing health insurance claims:
Papers you need to keep carefully for filing reimbursement claim
•Make sure you file all documents regarding your illness right from the time it was first detected.
•Keep all bills, prescriptions, and payments receipts of medicines and ancillary expenses.
•It is important to retain the bills and diagnostic test report. Make sure a note from the doctor concerned supports the reports so that it validates the need for the tests conducted.
•Please ensure that all the bills have the correct name and date.
•A discharge certificate from the hospital.
•A photocopy of all the bills and discharge card.
•A certificate from the attending doctor stating the nature or the treatment/surgery performed and also certifies the diagnosis.
•Also get a certificate, that the patient is cured
•In case the treatment continues at home, let this be prescribed by the doctor, when being discharged from the hospital.Things to remember when going for planned hospitalization
•When going for a planned hospitalization, remember to contact the Third-Party Administrator (TPA) for your health insurance policy.
•Inform them about your planned hospitalization at least 3-4 days before hospitalization. Remember to get your claim intimation number.
•Verify the Coverage
terms with your TPA to ensure your hospitalization will be covered.
•Also check if the hospital where you are planning to get admitted comes under your insurance provider’s Network.
•In case you have taken cashless policy, seek advice from your TPA about the process you must follow.Points to remember for emergency hospitalization
•In case of an unplanned or emergency hospitalization, inform the TPA as soon as possible for the claim form, preferably within 24 hours of admission.
•You can call or send email to intimate the TPA regarding hospitalization. Remember to note down your claim intimation number.
•At the time of admission show the identity card issued by the TPA or Insurer
at the hospital.
•Please note that your claim form along with supporting documents should be filed within 7 days of your discharge from the hospital. So keep all bills and prescriptions carefullyClaiming Medical Insurance
•Please note that pre- and post-hospitalization claims need to be filed separately. This is in case your Policy
covers pre-hospitalization expenses.
•Submit the duly filled and signed reimbursement claim form along with supporting documents such original bills, discharge certificate and receipts to the TPA or the insurance company.
•Remember to collect a stamped receipt after you physically submit the claim form.
•Insurance companies typically reimburse claims expenses incurred 30 days prior to and 60 days after the hospitalization.
•If your health insurance claims are rejected, file a complaint with the insurance company within 15 days.
•If you get partial payment on your health insurance claim, ask for reasons from your TPA. Sometimes, providing additional documentation might help recover remaining reimbursement claim.