Insurance Savvy
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Make your Health Insurance Claim a
Hassle-free Experience!
What should you do in case of a Health Insurance claim?You have a health insurance policy, but do you know what to do in case you have to make a claim. To ensure that you get your claims without any hassles, you should follow certain procedures given by the health insurance company. Given below are some tips to follow when you make your claim.
What should you do in case of a claim?
Claims are serviced in both networked and non-networked hospitals. You can make a claim in the following ways:
- Claiming through Cashless facility
- Claiming through Reimbursement mode
What is the procedure for claiming through cashless facility?
- Intimate the TPA (Third Party Administrator) within 24 hours in case of Emergency admission and before 72 hours incase of planned admission through the insurance helpdesk of the network hospital.
- Ensure that the hospital faxes the cashless request form (duly signed by you and the attending physician) to the TPA’s office with relevant medical records.
- The TPA may seek additional records or information from the hospital/physician for medical scrutiny. If the claim is admissible the TPA shall fax across the pre-authorisation/approval to the hospital.
- Before discharge any non-admissible expenses like telephone, diet, attendant charges etc. will have to be borne by you. Later, the insurance company will settle your bills to the hospital directly, through the TPA.
- If your cashless request is rejected by the TPA and if you have reasons to believe that the claim is admissible, you may file a claim on reimbursement mode.
What is the procedure for Reimbursement Claim?
- Avail treatment and settle all the bills with the hospital and file a claim for reimbursement
- Intimate your insurer within 7 days from the date of discharge. Do not forget to quote your Policy Certificate Number.
What are the documents required for filing a reimbursement claim?
- Duly filled claim form along with Doctor's certificate
- Discharge summary
- Bills
- Prescriptions
- Advance and final receipts
- Diagnostic Test Reports, X Ray, Scan and ECG reports etc
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