How to Get Claim in Health Insurance?

Do you know How to Get Claim in Health Insurance?
Types of Claim Settlement:
1. Cashless Claims Process
2. Reimbursement Process

1. Cashless Claim Process:

To avail of the cashless claim facility, the insured has to be treated in an impaneled hospital. By presenting the Icard or  Health Insurance Policy taken within the name of the insured, he or she can avail cashless treatment. It takes less than an hour to get cashless claim approval and once the approval process is done, the hospital’s TPA department will coordinate with the Health Insurance Company’s TPA to get claim amounts. After the time of discharge, you have to pay the amount of nonclaim items such as disposable items.

Cashless Claims Process for Planned Treatment in  Cashless Network Hospital:

Usually, the insured has to inform the insurance provider about the hospitalization or treatment requirement. A cashless claim request type should be submitted at the relevant address of the insurance provider – mostly via post, e-mail, or fax. For additional info, you’ll be able to contact the customer care of your insurance provider. Once these steps are completed, the insurance company can inform the insured regarding the policy cover and eligibility. On the day of admission within the hospital, the customer has got to show his/her insurance card or Policy Document in the Hospital TPA Department to get Cashless Claim.

The cashless Claims process for Emergency Treatment in Network Hospital:

The policyholder will contact the customer care to facilitate the desk of an insurance provider to get info about the closest network hospital. By displaying your health insurance card, you’ll be able to avail of cashless hospitalization. Other documentation and cashless procedure will be managed by the hospital’s TPA department. The medical bills are going to be paid by the insurance provider, directly to the hospital. Just in case of rejection of the claim, a letter is going to be sent to the insured, stating the reasons for rejection.

2. Reimbursement Claim Process:

The reimbursement claim for insurance is often made if the customer opts to go to a hospital of his/ her choice, which could be a non-impaneled hospital. During this case, the cashless claim facility cannot be used. Therefore, the insured needs to pay all his/ her medical bills and other costs involved in hospitalization and treatment. To avail reimbursement claim you have to provide the required documents as well as original bills to the insurance company. The company can then evaluate the claim to the insured. Just in case the claim is rejected. The insurance provider usually provides reasons for rejection.

Documents for Reimbursement Claim Process:

  • Duly filled the claim form
  • Medical Certificate (signed by the treating doctor)
  • Discharge summary and Case History
  • All bills and receipts (original)
  • Medicine and Hospital Bills from chemists and hospitals.
  • Investigation report
  • If it is an accident case, then the FIR or Medico Legal Certificate (MLC) is required.

Contact details of Health Insurance Companies

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