Steps to Follow To Get Your Health Insurance Claim Settled in an Easy Way!

If you have purchased a health insurance plan and are unaware of how you can go about the claim process, then this article rightly explains you everything you should know about health insurance claim process. Lack of knowledge and incomplete information can make your health claim settlement process seem like a cumbersome task. So simply follow the below steps to enjoy hassle-free and quick claim settlement.

Types of claim settlement

Under health insurance, there are two types of claims settlement which you can avail Cashless claim settlement-under this type, you are not required to pay anything at the time of hospitalisation. Reimbursement-under this type of claim, you are required to pay the hospital bills first and then get the reimbursement from the insurer.

Cashless claim settlement process explained in detail

• Cashless claim settlement service is offered by your insurer if you are hospitalized at any hospital that falls under the network list of the hospital.  Under this type of process, hospital is referred as Preferred Provider Network (PPN) and all the medical expenses are settled between the hospital and insurance company through third party administrator (TPA).

Reimbursement claim settlement process explained in detail

• This type of claim settlement process requires you to bear the medical expenses and then initiate a claim on the insurance company to reimburse the hospital bills.  The reimbursement amount will only be given on providing the required documents asked by the company.

Steps to follow for cashless claim settlement process:

Step 1: Check if the ailment is covered

• First, check if your health insurance plan provides coverage for the ailment you are affected with. Also, check if the hospital you are hospitalized in is covered under the network of your insurer.

Step 2: Intimate:

• Inform your insurance company about your hospitalization.
• In case of planned hospitalisation, inform 48-hours prior and within 24 hours in case of emergency hospitalisation.
• At the time of hospitalisation, you will be asked to fill a pre-authorization form and then asked to submit the same to Third Party Administrator (TPA).
• You will have to produce the health card at the time of hospitalisation.

Step 3: Keep the record:

• In case of cashless claim approval, your original documents will be retained by the insurer.
• For record, keep all the copy of the documents with yourself.
• For a fair claim settlement process, always keep the TPA informed and keep a record of hospital bills and doctor’s prescriptions as document proofs.

Steps to follow for reimbursement claim:

Step 1: Inform the insurance company:

• Intimate the insurance company and submit the duly filled reimbursement claim form within 30 days from the date of discharge from the hospital.

Step 2: Submit the original documents:

• Submit all documents such as medical reports, medical and hospital bills to the insurer. Ensure that all the copies submitted are original and not duplicate ones.
• Submit doctor’s prognosis prescription advising hospitalisation to show that you were genuinely unwell and required hospitalization to take care of your health.
• Hospital discharge card also needs to be submitted along with the follow-up medical prescription.
• Bills have to be submitted within 60-120 days from the date of discharge depending on the terms of your policy.
• A copy of all the original bills and form needs to be kept for future use.
• After receiving the bill, you can expect your insurer to settle the claims within 15-30 days.

Your health insurance policy will be of good use only if you know the right way to get your claims settled. So follow the above steps for speedy claim settlement process.