Steps to Make Cashless Claims towards Health Insurance read

Mar 17 2020


Unforeseen medical events are uncertain, and you never know when you’ll meet any of them. The prudent way of facing such circumstances is to get a suitable health insurance policy that helps you obtaining financial coverage towards medical aid.

A mediclaim backup gives you financial assurance. If you ignore it, you may suffer from a severe financial crunch. However, if the health insurance claim process is tiresome, the insured members lose interest which leads to not availing benefits.

The health insurance claim process is the process of getting reimbursement for the medical costs that have been incurred. Here are a few guidelines that can explain how to claim under the health insurance plan you have purchased when the need arises.

There are two types of claim settlement: Cashless & Reimbursement. Let’s see them one by one.

Steps for Cashless Claims

  • You can opt for cashless hospitalization when treated for an ailment. This means that the health insurance company will bear the cost of hospitalization, and the policyholder will only have to pay those parts that the health insurance company is not covering as per the insurance regulations.  The claim is approved basis the Terms and Conditions of the health insurance plan. Also, the concerned hospital should be a part of the insurer’s network of healthcare providers.
  • At the time of admission, you need to fill a pre-authorization form submit at the third-party administration (TPA) counter. Inform your insurance company beforehand as the TPA sends over the form for their final approval.
  • The Third-Party Administration counter will take into submission any pertinent documents. This may include the cashless health care provided by your insurer. Also, for verification purposes, copies of certain KYC documents will be retained.
  • By this time, the insurance company gives their cashless approval for your hospitalization. They keep an account of all the documents concerning your treatment and during your stay. It is advisable that individuals also obtain a copy of the same for record-keeping.
  • The claims will be settled smoothly if you follow the guidelines mentioned above. Ensure that all medical reports, physiological tests, discharge bills, etc. are intact with you. All these documentations must be kept for future requirements or references.

Steps for Reimbursement Claims

  • Reimbursement claims are how you can claim expenses incurred at an out-of-network hospital l. Inform your insurance company about your impending claim. Fill up and submit the reimbursement claim form to them. This must be done within a month from the discharge date from the hospital.
  • Along with the claim form, you need to submit the duly signed and sealed bills related to the hospital. Double-check for certain mandatory elements in the hospital bill. These include the registration number of hospitals, patient name, admission date, and the doctor’s prognosis prescription. The final document ensures that the hospitalization was not a self-made decision but a doctor’s recommendation.
  • Collect the Discharge Card that is given by the hospital on the day of release. This should be submitted to the insurance company.
  • One can also claim pre and post hospitalizations charges in reimbursement type of settlement. Here, you also need to submit the pertinent bills to the insurance company. It can be done within 60-120 days, according to the statements in their health policy.
  • In both types of claim settlement, you need to maintain all your medical and hospitalization data safely.

Earlier, the insurance buyers were intimidated by the financial jargon in the insurance policy; however, the situation is changing drastically. By scrutinizing every line, you can easily claim and settle their dues with the insurer. Claiming health insurance payouts by showing interest is easy, and needs just your attention.