How To Claim Health Insurance?

Posted on Mar, 2020
How To Claim Health Insurance?
Health insurance covers you against a wide variety of costs incurred during treatment – from hospital admission to surgeon fees and pre and post-hospitalisation to ambulance charges. You can either opt for cashless hospitalisation or file a reimbursement claim. However, claim filing process can become a bit confusing for a lot of people. If you are wondering how to claim health insurance, this article is for you.

How to claim medical insurance for cashless hospitalisation?

1. Check if you are eligible for cashless claims

The first thing you need to do is check if you are eligible for cashless claims. You need to check two things – whether the condition you are suffering from is eligible for coverage and whether the hospital you are seeking admission in, is covered under the insurer’s network.

2. Inform the insurer

Next, you need to inform the insurer about your intention to file a claim and the hospital where you will be seeking the treatment.

3. The hospital gets approval from the insurer

At the time of admission, the hospital will ask you to fill a pre-authorisation form and submit it at the Third Party Administrator (TPA) desk. The TPA representative then forwards the form to your insurer for cashless approval.

4. You need to submit documents

You have to provide your original health insurance policy, the cashless health card and ID proof documents for KYC at the hospital. The hospital takes a copy of your documents and returns the originals.

5. The insurer retains the original hospital bills

The insurer now approves cashless treatment and retains the original invoices for records. You may take a copy of the same for your records too.

6. Pre and post-hospitalisation costs are reimbursed

After getting discharged from the hospital, you have to submit the original bills of expenses incurred by you, before and after hospitalisation for reimbursement. The insurer reimburses your expenses within 21 days.

How to claim for health insurance in case of reimbursement?

1. Inform the insurer that you will be filing a claim

Inform the insurance provider about your intention to file a claim. The insurer will provide a claim reimbursement form, which you must submit within 30 days of being discharged from the hospital.

2. Submit the documents

You must submit all original documents along with the claim reimbursement form, including medical reports, hospital and medicine bills. You need to mention the hospital registration number and the patient name clearly on all invoices and forms. You also have to submit the discharge card issued by the hospital.

3. Submit the pre and post-hospitalisation bills

You now have to submit the bills for expenses incurred before hospitalisation. You can submit the post-hospitalisation bills within 90 days from the discharge date, based on the coverage offered under your insurance policy.

4. The insurer settles your claim

After all the documents are submitted, the insurer settles your health insurance claim within 21 days of registration.

It is natural for you to concentrate on seeking treatment instead of running around, filing insurance claims. In such situations, you can approach your insurance broker for help. At PINC Insurance, we help you file your health insurance claim and serve as your liaison with your insurance provider.