How To File A Health Insurance Claim

Medical crises strike without warning. Health insurance shields you financially. Know your policy inside out. Reimbursement or cashless? Both claim types offer protection. Master the process. Stay prepared for life’s curveballs. Your health and wallet will thank you.

How Can I Submit A Claim For Health Insurance?

The first step is to inform the insurance company about your health claim quickly. Then, follow the policy’s claim deadline. The insurer’s representatives will guide you. They explained the documents needed and how to fill out the claim form. If you’re late in notifying them, your claim might get denied. For more details, check the policy rules and the insurer’s instructions.

Categories Of Claims Made By Health Insurance

These are the two methods by which a health insurance claim can be submitted.

Cashless Claims Settlement

For cashless health insurance claims, the hospital and insurer communicate directly. First, inform the insurer, then go to a network hospital. Notify the hospital within 48 hours for emergencies or 72 hours for planned stays. After admission, contact the hospital’s insurance office. The staff will then send the needed documents and forms to the insurer. Having an approved pre-authorization form speeds up the process. The insurer then reviews the documents. If the claim meets the policy rules, they approve it and pay the hospital directly.

Reimbursement Claims Settlement

You can pick any hospital for treatment. First, pay out of pocket, then claim reimbursement. For emergencies, inform your insurer within 48 hours. Planned stays are done three days in advance. After discharge, send your bills, discharge summary, prescriptions, and reports to the insurer. They might ask for more documents. Once verified, your claim reimbursement typically arrives in 10 to 15 business days. Insurers may take up to 30 days in some cases. Your registered bank account will receive the deposited funds directly. Timelines vary, but rest assured your claim is being processed efficiently.

Hospitalisation Types That Are Covered By Health Insurance Claims

You can file a medical insurance claim for a variety of medical needs because most health insurance policies cover a range of hospitalisations. The primary categories are as follows:

• Emergency Hospitalisation: Needed for urgent care when illnesses or accidents strike suddenly.
• Planned Hospitalisation: Appointed medical procedures or therapies for ailments that are already recognised.
• Daycare Procedures: These include cataract surgery that doesn’t require an overnight stay.
• Pre- and Post-Hospitalization Expenses: These are costs for tests and follow-up care before and after hospital admission.

Documents Required When Submitting A Health Insurance Claim

• Claim Form (A and B): Download it from the insurer’s website or the hospital’s insurance desk.
• Medical Bills And Reports: Provide all original documents from the hospital.
• Discharge Summary: This document outlines your treatment and diagnosis.
• Prescription and Medical Certificate: Add a doctor’s prescription and a hospital need certificate.
• Identity Proof: Provide valid ID, like an Aadhaar Card, passport, or voter ID.

Filing a health insurance claim might seem hard. However, the above information can help. The process varies by claim type and required documents. So, ask your insurer about the claims process when buying a policy. You can easily file and manage your claims on the go using the ABCD app. It will ensure a smooth, efficient experience.