Cardinals for hassle-free settlement of health insurance claims

Health Insurances 163 views

Finding the right health insurance company is a tough task in itself because of the varying terms and conditions related to waiting period, cover for pre-existing diseases, day-care procedures, critical illness and many more. But even more critical is the claim filing experience. Sometimes it is difficult to get the claim settled by the health insurer who quote some negligence on the part of the policyholder while filing the claims. Just imagine how excruciating it will be for you when your insurer will reject your claim because of reasons that you may not be aware of before the filing of claims. In order to avoid such situations, you must follow the below mentioned points and reap the benefits of hassle-free claim settlement with respect to the expenses incurred on the hospitalization.

Do not delay in filing claims

The first and foremost thing that you need to do is to stay proactive by intimating your health insurer or TPA immediately. In case of planned hospitalization, you have the time to avail cashless claims. However, it is imperative for you fill up the cashless authorization form at the network hospital of the insurer at least 7 days before the date of hospitalization. But if you face an emergency like situation and get yourself treated at a hospital other than the ones in the list of empaneled hospitals, then you should intimate your health insurance provider during the time of admission. You need to make the claim within 30 days from the date of discharge from the hospital. Else, the claim can be rejected by the health insurer.

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Choose Policy with Limited or no Sub-limits

You should focus on buying a health insurance with less or no sub-limits, which bring down the claim amount for specific hospitalization or medical treatment even with a bigger sum assured amount. You must fill up the proposal form disclosing all the facts that are asked in the same. On non-adherence, the claim can either be rejected or held up for further discussion in the future. So, you need to provide exact information such as consumption of liquor/tobacco, diseases, occupation, income, etc.

Avoid Non-registered Hospitals

So often the claims get rejected as people get themselves treated at hospitals, which do not have a valid registration certificate. Get yourself treated at a recognized and registered hospital so that you can get claims settled without any hassles. You can go online to find whether the hospital where you want to get treated is registered or not.

Maintain Documents Chronologically

You must maintain the list of documents related to the treatment of diseases/illnesses during the hospitalization. Make sure you do it chronologically so that you can find the document easily for submission. The list of documents will include the copies of bills, investigation reports, consultation sheets, discharge summary and others. The original copy of these documents will have to be submitted while filing the reimbursement claim. However, if you choose cashless service, make sure you maintain the copies of the documents stated above so that you can have a record of your hospitalization if asked to submit in the future.

Keep All the Medical Proofs

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Your insurer may view the medical treatment as unnecessary. In order to counter such move, it is imperative you keep a proof of doctors' opinions recommending you to go for the treatment.