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Steps to Get Health Insurance Claims Faster Research Team | Posted On Monday, September 09,2019, 05:23 PM

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Steps to Get Health Insurance Claims Faster



Health insurance policyholders must follow certain steps to get their health insurance claims faster. Before we get to the subject, let’s first understand the concept of health insurance. If you are a first-time buyer, you must know what’s health insurance. Health insurance, also called mediclaim, covers the medical costs of a policyholder.

In other words, it is an agreement between the insurance company and the policyholder; wherein the insurance company agrees to reimburse the surgical and medical expenses when the policyholder gets hospitalized for illnesses or injuries. Remember that health insurance works according to the agreed terms and conditions.

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Steps to Get Health Insurance Claims Faster

Why Health Insurance?

Today, health insurance is required for self and family members as health care has become very expensive. If you or any of your family members is hospitalized, you need a health insurance plan.

Arranging funds at the last moment is difficult. Sometimes, you may have to compromise on your medical treatment. So, buy health insurance and ensure a better life.

For instance, Herceptin, which is a medicine used to treat cancer, will cost you roughly Rs 1,10,000 for a viral of 440 mgs. Cancer patients may need up to 17-19 bottles based on the severity of the disease. Can you afford to pay this huge an amount? This is why you need health insurance.

See Also: Health Insurance Benefits

Categories of Health Insurance

Health insurance or medical insurance is broadly categorized into three lists, which include hospitalization policies, hospital daily cash benefit policies and critical illness policies. Hospitalization policies also referred to as indemnity policies, reimburse the medical and hospitalization expenses of a policyholder.

Hospital daily cash benefit policies reimburse a defined sum of money for each day of hospitalization; irrespective of the actual expenses. Critical illness policies pay up a lump sum amount when the policyholder is diagnosed with a critical illness as specified in the policy.

Types of Health Insurance Claims

There are two types of claim settlements: 1) cashless claims and 2) reimbursement claims. Health insurance policyholders may opt for a cashless settlement in case of planned hospitalization. The concerned insurance company will settle the medical or health care expenses with the network hospital.

Many health insurance policies offer the facility of cashless claims if you avail medical treatment at the network hospital. (This hospital has a tie-up with the insurer).

 Steps to Follow to Get Cashless Claims Faster

  • Step 1: Check whether or not the ailment is covered according to the conditions and terms of the health insurance policy. If yes, get hospitalized at a network hospital to be able to avail cashless claims.
  • Step 2: You would be asked to fill a pre-authorization form at the hospital. Do not delay the submission.
  • Step 3: Submit the required documents, including KYC documents, at the third-party administrator. Do not forget to collect the original documents. You may just have to produce a copy.
  • Step 4: The insurer would retain the original documents related to the hospitalization; once they approve the cash settlement claim.
  • Step 5: Understand the pre and post-hospitalization expenses covered under your health insurance policy. Retain the medical bills, prescription and medical reports in order to claim the same.

See Also: How to Buy Health Insurance Policy?

Steps to Follow to Get Reimbursement Claims Faster

Sometimes, you may have to opt for reimbursement claims if you are hospitalized at a non-network hospital. To get claim settlement fast, just follow these steps:

  • Step 1: Keep your health insurance company informed on the illness and the treatments you have undergone.
  • Step 2: Produce the duly filled reimbursement claim form within the given deadlines.
  • Step 3: Produce all the original documents, hospital bills and medical bills duly signed with the claim settlement form. The hospital bill must clearly mention the registration number of the health care centre or hospital, the name of the patient and the date of admission.
  • Step 4: Once you are discharged from the hospital, the hospital will issue a discharge summary or card that states that you are OK to be discharged. This card has to be submitted to the insurance company.
  • Step 5: After hospitalization, the follow-up prescription of the doctor must also be submitted to the insurer.
  • Step 6: As far as post-hospitalization expenses are concerned, you may furnish the medical bills within 60-120 days from the date of discharge.
  • Step 7: For further references, make sure to retain the copies of all the original documents. The claim shall be settled within 2 to 3 weeks from the date of policy registration.

See Also: Health Insurance for Disabled

Prime Benefits of Health Insurance

The prime benefits of health insurance include cashless treatment, post and pre-hospitalization expenses, transportation expenses or ambulance charges, free health checkups, room rent, tax benefits u/s Section 80D of the Income Tax, Act, 1961 and others. You can avail individual health insurance policies, while families can avail family floater health insurance plans.

How to Select the Right Insurance Policy?

Decide how much sum assured is required. Make it a point that the sum assured you choose is adequate. Understand about the guaranteed renewability clause and the minimum age of entry. Pay attention to the inclusions and exclusions of the policy you are going to choose. Compare and analyze various types of health insurance plans available in the market. Do not be in a rush to avail a health insurance plan.

The very important thing you must consider is your family medical history. In India, people under the age of 45 years do not have to undergo mandatory health checks-ups prior to buying a health insurance plan. But, you have to disclose the pre-existing conditions if any without hiding them. The details you furnish at the time of purchase must be completely reliable and accurate.

Even smokers can avail health insurance, but at higher premiums. It’s difficult to hide the smoking habit. Blood and urine tests can detect nicotine in your body. Smokers must avail health insurance as they are prone to smoking related illnesses.

See Also: History of Health Insurance in India

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