In today’s world, it is essential that every individual owns health insurance. It acts as a financial backing when there is a medical emergency. A claim is a request that a policyholder would have to make to receive compensation for the expenses incurred during treatment. Read further to understand how to make a claim.
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Reimbursement Claim
This is the method by which many insurance companies deal with claim procedures. In this type of claim, the policyholder will pay for the treatment and then file a claim within the required time. They would have to file the claim with all the necessary bills and documents to prove that the treatment was done and after the verification, the insurance company will provide the policyholder with the claim amount. There are several reasons for claim rejections so, make sure you do everything possible to avoid claim rejections
Reimbursement Claim Procedure
- Most insurance companies expect the claim to be made within 7 days
- Contact the insurance company through the toll-free number provided and provide the membership number
- After settling the hospital bills, present the bills, prescriptions, discharge summary, and everything required for making a reimbursement claim
- Visit the official website of the insurance company, download, and fill the reimbursement form
- Submit the form along with other records to the insurance company
- The insurance company will verify everything and if the claim is approved, the claim amount will be sent 20 days from the date the claim is made
Cashless Claim
This is a comparatively new method and insurance companies are beginning to adopt this method. This claim method allows the policyholder to receive treatment without having to pay the hospital directly, provided they are treated in any network hospital. On admission, the policyholder would have to produce the cashless health card provided by the insurance company and the insurance company will directly settle the claim with the network hospital.
Cashless Claim Procedure
- Choose a network hospital mentioned in the insurance document
- Inform the TPA (Third Party Administrator) at least 3 days before admission and provide the insurance membership number
- Fill the cashless request form within the required time
- Submit the form and medical record to the TPA
- After the TPA verifies the documents and approves the documents, the insurance company will settle the bills
- If the cashless claim is disapproved, one can try making a reimbursement claim
Requirements for Initiating an Insurance Claim
- Policy number
- Health insurance card
- Personal information of the policyholder such as name, address, ID proof, etc.
- Reason for the required medical care
- Personal information of the doctor or medical care provider
- Details about the hospital where the policyholder gets treatment
- Date of admission
Points to Remember While Filing Health Insurance Claim
- Act quickly and make a claim as early as possible
- Contact the insurance company
- Charges such as telephone calls, laundry services, and visitors passes are not covered by all insurance companies
- All the forms must be filled correctly to avoid claim rejection
Making an insurance claim can seem like a very tedious process as one is warned that everything must be done with great care. While both have their pros and cons, one can choose a claim method that is convenient for them. To know more about health insurance plans, click here!
