How to claim health insurance?

How to claim health insurance?

by 5paisa Research Team Last Updated: Feb 16, 2023 - 12:32 pm 828 Views

Buying the best health insurance would only make sense if the claim settlement process is smooth enough. In this article, we would be explaining how to claim health insurance.

 When a policyholder is hospitalised or has a medical emergency, his or her health insurance policy kicks in. The insured individual might then need to request the insurance provider to pay for their medical expenses at that point. This is known as filing a claim for health insurance coverage.

The best health insurance coverage can give the financial support required to receive medical care on time. However, medical bills might quickly deplete your savings. That is why learning how to file a health insurance claim may be quite beneficial. Continue reading to learn how to file a claim for your health insurance.

Claiming Health Insurance

Individuals with health insurance can choose between a direct claim settlement (cashless treatment) and compensation for health services received. An insurance company pays the claim amount straight to a network hospital under the cashless claims process of health insurance.

Only hospitals where the insurer has made prior arrangements to provide this option to are eligible for a cashless facility. They are referred to as network hospitals or empanelled hospitals. When using a reimbursement facility, you must pay all medical bills in full upfront and submit a claim for reimbursement to your health insurance provider later.

You can follow these steps to get a cashless claim with planned hospitalisation:

Step 1: Notify your insurer/TPA of your intended treatment at least 3 to 4 days in advance. 

Step 2: Obtain a pre-authorization form from a network hospital or online from the TPA's website. 

Step 3: Complete it and turn it into the insurer's/TPA desk at the hospital where you wish to be treated. 

Step 4: Bring all necessary documentation to the TPA counter. 

Step 5: If your application is approved, the insurer/TPA will send you an authorization letter and notify the hospital of your treatment. 

Step 6: To receive cashless treatment, present your health insurance ID card and pre-authorisation letter on the day of admission.

To file a claim for reimbursement, please follow these steps:

Step 1: Ensure that any medicines, medical records, and expenses accumulated while your treatment is carefully stored.

Step 2: Obtain the discharge certificate or discharge report from the hospital upon discharge.

Step 3: When filing claims for medical expenses, ensure that they are certified and signed by the hospital.

Step 4: Submit the claim form fully completed and signed, together with any pertinent original papers, to the insurance provider.

Step 5: Ensure that you submit your claim within 7 to 15 days after receiving hospital release.

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