How to Claim Medical Insurance from a Company?

Medical insurance is like a safety net that helps pay for your healthcare when you are sick or injured. Knowing how to use claim insurance is important so that you can get the help you need without any problems.

Before getting to know how to claim medical insurance step-by-step, you must be aware of the different types of insurance, as the process of claiming may vary.

Types of Health Insurance Claims Based on Claiming Process

When you need medical care, your insurance can help cover the costs. There are two types of health insurance claims:

Cashless Claims

In this type of claim, you do not have to pay the hospital bills upfront. Instead, your insurance company pays the hospital directly. However, this is possible only if you get treated at a hospital that has an agreement with your insurance company.

Reimbursement Claims

In this type of claim, you need to pay the hospital bills from your own pocket. Later, you provide documents, and your insurance company pays you back. This can be done even if the hospital does not have an agreement with your insurance company.

5 Steps to Make Cashless Claims

Here is how you can make cashless claims from network hospitals:

Step 1: Choose the Right Hospital : Before getting treatment, check if the hospital is part of your insurance company's network. You can find this list on your insurer's website or by getting in touch with their customer service.
Step 2: Inform the Insurance Company : Planned Treatment: If you know about your treatment in advance, inform your insurer at least 3 days before admission. Emergency Treatment: In sudden situations, inform your insurer within 24 hours of getting admitted.
Step 3: Show Your Health Card : At the hospital, present your insurance health card and a valid ID proof at the insurance helpdesk.
Step 4: Fill Out the Pre-Authorization Form : The hospital will provide a form that you need to fill out to get approval for cashless treatment. The hospital will then send this form to your insurance company for approval.
Step 5: Approval Process : Once the insurer approves, you can receive treatment without paying the hospital bills upfront. Remember, some expenses not covered by your policy might need to be paid by you.

5 Steps to Make a Reimbursement Claim

If you are opting for treatment in a non-network hospital, you can make a reimbursement claim in the following way:

Step 1: Inform the Insurance Company: Notify your insurer about your hospitalization as soon as possible. 48 hours in general and at least 24 hours in case of emergency.
Step 2: Collect All Documents: After treatment, gather all necessary documents, including:
Original hospital bills and receipts
Discharge summary
Doctor's prescription
Diagnostic test reports
Other relevant medical documents
Step 3: Fill Out the Claim Form: Obtain the claim form from your insurer's website or office, fill it out accurately, and attach all the collected documents.
Step 4: Submit the Claim: Send the completed form and the documents to your insurance company within the time frame specified in your policy, usually within 15 to 30 days after discharge.
Step 5: Claim Processing: The insurer will review your claim and, if everything is in order, reimburse the eligible expenses to your bank account.

Important Tips to Claim Your Medical Insurance

Before maintaining insurance claims from your provider, make sure you are aware of the following:

Understand Your Policy: Read your insurance policy carefully to know what is covered and what is not.
Keep Copies: Always keep copies of all the documents you have submitted for your records.
Stay Within Time Frames: Inform your insurer and submit claims within the specified time frames to avoid rejection.
Resolve Your Queries: If you are unsure about any part of the process, do not hesitate to contact your insurance company's customer support or helpdesk for clarification.

By following these steps and tips, you can smoothly claim your medical insurance and focus on getting better without worrying about breaking the bank or exhausting your savings.