Useful Facts About Health Insurance Claim

Health Insurances 162 views

In many circumstances, health insurance claim can be a very tiring process. Moreover, the situation becomes even worse, if you get no help from the health care provider. Usually, people are left to fend for themselves, when it comes to filing the health insurance claim for the medical reimbursement that generally occurs after hospitalization. More to the point, in such scenario, the cashless facility will not be provided by the hospital or the nursing home. However, the expense incurred on hospitalization can only be claimed once the patient gets discharged or after the completion of the treatment.

If you are the one who is willing to file his own insurance claim, below are some important points that you should always keep in mind:

Keep a Record of All the Receipts

  • It would be advisable for you to keep the record of all the receipts, bills and as well as medical reports as part of the hospitalization.
  • Moreover, you should also maintain the records of the documents 30 days before to hospitalization and 60 days subsequent to hospitalization.
  • These medical bills, receipts etc with having the name of the service provider mentioned on it along with the document number , patient's name, date, name of the consultant, services availed help you a lot in the process.
  • In order to file the claim, you need to submit the original documents along with the xerox copies.
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Receive the Claim Form from Insurance Company

  • If you want to file your health insurance claim, the next step that you need to do is to get the claim form from the health insurance company. Moreover, you can also download the form online.
  • Then the form needs to be filled with self-explanatory. In this form some queries such as your cover details, reimbursement of the medical expenses, reason of hospitalization, personal details, ID proofs etc are asked.
  • This claim form carries some additional instruction details which you must ready very carefully. It must have the signature of the policy holder along with the treating consultant.
  • The form should be stamped with the official seal of the hospital just for the authentication of the claim.
  • This form is also accompanied by few relevant documents such as medical documents and policy documents.

Prepare the Original Copies for the Claim Submission

  • Always remember to submit the original documents while claiming the policy. If you are not having the originals, you won't get the claim of your health insurance.
  • In fact not only the original documents, but a set of xerox copies also need to be submitted.
  • Keep the documents in the chronological order because it helps you in avoiding the further confusion, and it is also important to carry the xerox for a safer side.

Review & Dispatch of Documents

  • Once you are done with the compilation, it is highly important to re-check your documents.
  • You need to verify and cross-check all the documents in order to avoid the claim shortfall.
  • Check whether all the documents are relevant to the treatment or not
  • Approach your local TPA where the documents of your claim settlement have been submitted.
  • After completing all the pre-requisite formalities, submit your claim to the customer care executive with the concerned TPA.
  • Inform the company regarding the submission of the claim by sending them all the xerox documents.
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Having Deep Understanding of the Fine Print in the Policy

  • Usually all the health insurance claims have to be claimed immediately after the completion of the treatment or discharge from the hospital.
  • You need to have proper documentation as per the terms and conditions of the insurance company in order to get the claim.
  • It is important for you to understand that the entire medical expenses incurred during hospitalization may not be reimbursed to the one who is claiming for it.
  • Also, keep a note of all the deductions or the medical expenses that are not included in your medical cover. Understand each and every single clause, and have a clear picture of your health insurance policy.

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