21 Jun 2024

Blog Post

Things to Know While Claiming Health Insurance

Things to Know While Claiming Health Insurance 

Buying a health insurance policy grants you peace of mind. With the right policy, you can fight the rising cost of healthcare effectively. To receive the benefit, you just have to contact your insurer in times of emergencies and apply for receiving the cover. This process is known as insurance claim. 

Steps to process a claim

There are two kinds of claims, cashless and reimbursement. 

Cashless claim

Here are the four steps to file a called claim.

  1. At the time of hospitalization, check if the required treatment is covered under your mediclaim policy and if the hospital is listed in the hospital network of your insurer.
  2. In the hospital, show your cashless insurance card along with a valid ID proof, fill the Pre-Authorization Form and submit it at the Third Party Administration. This form is then sent to your insurer for approval; do not forget to intimate your insurer.
  3. When asked, submit the required documents along with the one provided by your insurer for cashless treatment cover.
  4. At the time of hospitalization, check if pre- and post-hospitalization expenses are covered by your insurer and claim for the same.

Reimbursement claim

Some health insurance plans do not have the cashless treatment facility. In that case, you need to follow these four steps to make a reimbursement claim.

  1. Within 30-days since the release from the hospital, contact your insurer with a correctly filled reimbursement form that you can get either from their website or from the nearest branch.
  2. With the form, attach all the documents regarding hospitalization, bills, medical reports, and the prescriptions from the doctor. The documents must mention the dates of treatment and the name of the patient. The bills should have proper information regarding the hospital, including the registration number.
  3. The hospital discharge certificate must be included with the claim form.
  4. The cover for the pre- or post-hospitalization expenses can be claimed separately within a certain period, as mentioned in your policy documents.
  5. You should retain the copies of all submitted documents for future reference. The claim will be settled within two-three weeks after it is registered; this period depends on the terms of the insurance policy.

Difficulties you might face when making a claim

Making a medical insurance claim requires you to know the entire process thoroughly and follow it closely. Hence, there are times when you might face certain difficulties. The most commonly faced challenge is when your insurer does not provide cashless treatment. In that case, you have to provide all the documents gathered from the hospital to your insurer. One missed document can delay the reimbursement.

Also, not communicating clearly with your insurer can affect your claim process. You always need to be aware of all the inclusions and exclusions of your policy. It is also of utmost importance that you clearly know within how much time you have to make your claim in case of reimbursement. You must be very careful about these while making the claim. 

To make the process of claiming for mediclaim policy for family or an individual much easier, consider the online claiming option. It makes the entire process faster and you can do it from anywhere. 


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