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How to Get Your Medical Insurance Claim Settled Smoothly

Posted by Royal Sundaram on 05 Jun 2013

Hospitalization expenses can drill a hole in your savings. This is why people opt for health insurance plans to meet such eventualities with ease. Health insurance companies offer to settle claims in two ways, reimbursement of the bill paid by the insured or through cashless hospitalization. Cashless hospitalization is a hassle free means of claiming the benefits of the policy as the TPA of the provider will directly settle the hospital bill, for admissible claims, provided the insured is admitted in a network hospital.

In case you haven’t undergone the treatment in a network hospital or haven’t opted for the cashless facility, then don’t worry about the claim settlement. Here’s how you can go about it smoothly –

  • To start with you need to give a intimation of the proposed admittance to the insurance company,
  • Before you make the claim, go through the policy conditions to check if the particular disease is covered or falls under any specific exclusions in the policy.
  • File all the bills related to pre as well as post hospitalization including prescriptions and receipts of consulting fees paid to doctors, invoices and receipts provided by the hospitals and the pathology lab, the consultation reports and receipts carefully
  • To find out who will handle the claims call up your agent or broker, they would provide you with end to end help
  • A very important document in the process of claim settlement is the receipt. Submission of an invoice is a liability, but the receipt is a document that proves the payment had been done.
  • Fill the claim form accurately. The form can be availed from the Insurance Company. In case you are insured under a group insurance plan then the form can be availed in the HR department.
  • Your claim needs to be supported with a few essential documents as mentioned below. Keep a photo copy of each of these documents with you and submit the original to the TPA –

Claim form filled and signed by the insured. In some cases it may also need the signature of  the  doctor.

Discharge card is essential as it contains details like date of admission and discharge, treatments and follow-up checks you need

Letter of 1st consultation, advice for hospitalization needs to be on the letter head of the doctor with his signature.

Hospital bills that are pre numbered, stamped and contain the registration number of the hospital.

Medicine bills and doctor’s prescription with the patient’s name mentioned therein are required.

Consultation receipts, these are proofs of payment made to the doctor.

 Remember, all these documents need to be sent to the Insurance company within 7 days of hospitalization.

The settlement of an insurance claim process can take a minimum of 21 days, the duration could extend if you miss to provide any details in the first place. So be patient. You can keep track of your claim settlement process by following up with your broker, agent or Insurance company.

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