Health insurance claim procedure


There are some key documents needed while claiming health insurance.  We take health insurance to help at times of need.  When a sudden accident happens, we are busy with several things and here are the important things to do for a health insurance claim.

Sometimes we get admitted in hospital for treatment and sometimes take treatment as outpatient and sometimes we plan treatment for certain health problems.  In case of accidents and heart attacks, the patient has to be taken to hospital emergently.  It is very important to note the methods of claiming health insurance at different situations.

Documents needed for claim…

·         Doctor prescriptions, bills and receipts from the day of admission.

·         Check whether dates and name are correct on the above.

·         Discharge card from the hospital at the time of discharge.

·         Have Xerox copies of prescription, bills, and receipts.  Attach a set of Xerox along with the original ones along with the claim and have one Xerox set with you.

·         You have to obtain claim form from the company that may be either available in the website or can be obtained from the agent.  Fill it properly and collect the required bills, prescription and receipts in chronologic order.

·         Health insurance copy.

·         Card issued by third party administrator (TPA).

·         Signatures of the policy holder and doctor confirming the claim.

·         Recommendation by the dictator to get admitted.

Contacting while applying for claim…

·         To be informed through toll free number or e-mail before or within 24 hours of admission.

·         The formalities of claim have to be completed after discharge or within 7 days of completing treatment.

·         Remember that insurance companies will not pay for the documents not per their rules.

·         Insurance companies do not pay all the hospital expenses but only those applicable.  So, always read the document carefully while buying it.

For cashless treatment…

·         An identity card is issued by TPA or insurance company after purchase.  You have to produce this at the hospital before admission.

·         The insurance company has to be informed within 24 hours of admission after which the company will allot claim intimation number.

·         Preauthorization per the company rules is must to get cashless treatment.

·         Cashless treatment is available only for the hospitals in the network whereas others have to be claimed by submitting bills and receipts.

·         Some hospitals collect 15 to 20% deposit based on TPA agreement, which is refunded at the time of claim.

For reimbursement…

·         Get discharge card from hospital after getting discharged.

·         Discharge card, bills, receipts should be on hand.

·         Doctor recommendation is needed in case continuation of treatment is needed at home.

·         Claim form, original bills, discharge card, and other documents directed by the insurance company have to submitted to get the claim.

·         In order to submit the claim form directly to the company, you will need receipt with the company’s header.  In case direct submission is not possible, it is safe to send it through speed post, courier or registered post for delivery assurance.