Health insurance, no doubt, holds immense importance considering today's lifestyle and increasing health hazards. We, being mere human beings, can't really sit at our homes and predict the next date of our sickness. Having said that, neither can we predict our future hospital bills. If you are lucky enough to escape with some minor disease, you're good. But not everyone's going to be lucky in this aspect though.
This is the reason why health insurance policies in India call for immediate action. And it is a must for all to secure the lives of theirs as well as their loved ones or family with a good medical insurance plan as per their financial capabilities and other requirements. A health insurance policy basically provides you with the hospitalization cost in case of any health emergency.
To avail the benefits under a health insurance plan, it's quite clear that you will need to buy one. And to avail financial aid from your health insurer in case of any health issues, you will be required to file a claim with your health insurance provider.
After the acceptance of the claim from your insurer, the company will either reimburse the hospitalization costs or directly pay the hospital. Note that it's imperative for your health insurance claim to get accepted by the insurer. And in case of rejection of your claim, you will not be entitled to receive any benefits.
Now let's talk about the procedure for filing a health insurance claim with your insurance company. There are basically two types of health insurance claim process:
- Cashless Claim Process
- Reimbursement Claim Process
Cashless Health Insurance Claim Process
If you want to avail the benefits out of cashless health insurance claim, first you will have to make sure that the insured is being treated at an empanelled hospital or an empanelled medical institution. Thereafter, you can provide the details of the medical insurance policy and present the e-card or other similar physical evidence of the health policy purchased in the name of the policyholder to register a cashless health insurance claim.
In addition to that, as a plan B, the claimant may avail cashless treatment if the injury or illness is covered under the health insurance plan purchased. All the medical bills and hospitalization costs will be sent to the insurance company by the hospital right after the patient is discharged from the hospital. In the next step, your health insurance provider will evaluate the expenses and settle the payment with the hospital directly.
You need to keep in mind that the health insurance claims process for treatment at a cashless network hospital varies on the basis of the type of treatment taken:
As the name suggests, unplanned or emergency medical treatment at a cashless hospital network generally happens in the event of a medical emergency.
Health Insurance Claims Process for Planned Hospitalization at the Cashless Hospital Network
To register a claim with the health insurance provider for planned treatment at the cashless network of hospitals, the insured, in general, has to intimate the insurer about the treatment or hospitalization prior to availing cashless treatment.
- You must make sure that you inform the health insurance company at least 4 days prior to the date of treatment or hospitalization.
- You will have to submit a cashless claim request form at the relevant address of the health insurance provider – typically via e-mail, post, or fax.
- To avail further information, you can contact the customer service desk of your respective health insurance provider.
- After the successful completion of all these steps, the insured, as well as the concerned hospital, will be notified by your health insurance provider regarding the eligibility and policy cover.
- The policyholder will have to show his or her health insurance card (e-card) as well as the confirmation letter on the day of admission in the hospital.
- After the treatment had been done, on the day of discharge, the medical bills will be paid by your health insurer to the hospital, directly.
Health Insurance Claims Process for Emergency or Unplanned Hospitalization at the Cashless Network
To register a claim with the health insurance provider for emergency or unplanned treatment at the cashless network of hospitals:
- The policyholder will be required to get in touch with the customer service desk of his or her respective health insurance provider in order to get necessary information regarding the nearest network of cashless hospital.
- You can avail cashless hospitalization at the network hospital by showing your health insurance card.
- The hospital will be required to fill in the cashless claim request form.
- The form thereafter will have to be submitted at the relevant address of the health insurance provider – typically via post, e-mail, fax or via customer care service desk of the insurer.
- After that, your health insurer will issue an Authorization Letter to the hospital to intimate the hospital regarding the policy coverage.
- Your health insurance provider will pay all the medical bills to the hospital directly.
- However, the event of the rejection of the health insurance claim, the insured will be sent a letter from the side of the insurance provider, stating the reasons behind their rejection.
Reimbursement Health Insurance Claim Process
To register a reimbursement claim with the health insurance provider:
- The policyholder may choose to file reimbursement health insurance claim with his/her health insurance provider given that the policyholder opts to go to a hospital of his/her preference, which is a non-empanelled hospital.
- Under such circumstance, it is understandable that the cashless health insurance claim facility cannot be used.
- As a result, the insured will have to pay all his/her medical bills or hospitalization costs involved in hospitalization as well as treatment from their own pocket and then file a reimbursement claim with the health insurer.
- Keep in mind that you will have to provide all the necessary documents including original bills to your health insurance provider in order to avail reimbursement claim.
- Thereafter, the company will evaluate the claim to see its extent under the coverage offered under the plan and then make a payment to the insured.
- Also not note that the health insurance provider will reject your claim if the treatment is not covered under the plan. In general, health insurance providers give reasons for their rejection of claims.
Documents Required for Filing Health Insurance Claims
Now since you have well understood the process for filing a health insurance claim for different types of treatment, you should also know the documents that are required to ensure that your claim does not get rejected by the insurer.
Note that the following documents are required in order to make a successful claim with your health insurance provider:
- Duly filled claim form
- Medical Certificate/Form signed by the doctor who was in charge of the treatment.
- Discharge summary or card (original). You can avail this from the hospital.
- All bills and receipts (original)
- Cash memos, prescription from pharmacies or the hospital.
- Investigation report
- In case of an accident case, you will be required to submit the FIR or Medico Legal Certificate (MLC).
Buying health insurance doesn't end all your worries. You must make sure that you renew it, otherwise, you will have no longer be covered and you will also lose your continuity benefits waiting periods for pre-existing diseases. Before filing a health insurance claim with your insurer, you must make sure that you know your coverage options well. Because if you file a health insurance claim for an injury or disease this is not covered under your plan, you can be sure of its rejection.
In addition to that, you must also make sure that you are submitting all the necessary documents to support your claim. The pain of health insurance claims rejection could be very intense. Meanwhile, if you are planning to buy a good medical insurance plan for yourself or your family, you must make sure that you are choosing the right.
To help you with this, GIBL.IN, the fastest growing insurance marketplace in India makes sure you avail the best health insurance plan in India for the lowest guaranteed premium. You can compare countless health insurance plans as per your requirements from all the health insurance providers in India in a few clicks of your mouse.
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