A health insurance claim is a request made by the policyholder to the insurance company to avail themselves of all the facilities and medical benefits provided by their health insurance. This claim is made in order to get the money they need to cover their medical expenses. These can be either cashless or you can get the cost of your medical expenses as per your wish or demand. Your insurance company can provide you with your insurance money in either of these ways.
What are these two different insurance claims?
Any health insurance claim ensures that you provide financial assistance in case of any medical needs. And you can claim this insurance whenever you feel you have a medical emergency. In case of any medical need, you can avail your claim in these two available modes.
1. Cashless claims
In this mode of claim, you can directly visit the hospital and easily clear all your medical bills without any hassle. You don’t need to have any transactions in cash for this mode of claim. The only criteria you need to fulfil is that you must get admitted to a network hospital; otherwise, you might not be able to avail your claims later.
2. Reimbursement claims
You need to pay the money in this claim process during your medical treatment term, and you can get your money later on after availing your claim from the insurance company. The benefit of this claim is that you don’t need to visit any network hospital; you can get treated anywhere you wish to.
What is the claim process?
These are the steps you need to follow if you want to claim your life insurance, whether it is a cashless claim or a reimbursement claim.
Cashless Health Insurance Claim Settlement Process:
Here are the following steps you need to take care of when claiming cashless health insurance:
Step 1.
Get into a nearby hospital and make sure it is a network hospital of your following insurance company. And then contact the hospital for further assistance regarding health insurance.
Step 2.
Show your health card offered by the insurance company so that they can complete your identification process.
Step 3.
You will get a pre-authorization form for cashless treatment after they have completely verified your identity using the health card.
Step 4.
Later, fill out the pre-authorization form provided by the hospital and further submit it at the insurance desk.
Step 5.
Now The network hospital will submit your pre-authorization form to the health insurance provider after you have successfully filled it out.
Step 6.
Now your insurance company will check your submitted pre-authorization request form and your submitted documents. And then they will further approve your cashless claim according to the terms and conditions of the health insurance policy. Also, they can provide you with a field doctor in order to make your cashless claim authorization process smooth.
Step 7.
Now, during the moment of discharge, you need to pay for your medical expenses, which have not been covered under the health policy.
Step 8.
And after that, the insurance company will pay the bills and claim amount directly to the hospital according to the terms and conditions of their policy.
Reimbursement Health Insurance Claim Settlement Process:
Here are the following steps you need to take when claiming a reimbursement for health insurance:
Step 1.
The process starts with informing your health insurance provider that you have been hospitalised, and it should be done as soon as possible.
Step 2.
Now you should start your treatment at your desired hospital.
Step 3.
After your medication is over, you need to pay all your bills and charges before completely leaving your hospital premises. And make sure you collect all your documents after you have successfully paid your hospital bills.
Step 4.
After that, you have to submit all the necessary documents to your life insurance provider’s company.
Step 5.
After this, your insurer will review all your submitted documents and then process your claim according to the terms and conditions of the health insurance policy.
Step 6.
After you are done submitting your claim and once it has been approved, you will receive your claim amount from your insurance company.
Documents required for a health insurance claim
These are the documents you need to have in order to file a health insurance claim.
Health Card (Health Insurance ID Card)
All the consultation papers provided by the doctor
Completely filled-in claim form
All the investigation and diagnosis reports, such as CT scans, X-rays, blood reports, etc.
Hospital bills with payment receipts
Medico-Legal Certificate (MLC) or/and FIR (in case of accidents)
Invoices from the pharmacy with respective prescriptions and payment receipts
Discharge summary
Any other relevant documents requested by your insurer.