How to Claim Health Insurance?

Health Insurance Claims: Easy Steps to Follow

The process of claiming health insurance may differ depending on the type of health insurer and the policy type. However, here are some basic steps to follow for claiming health insurance:

Step 1: Understand Your Health Insurance Policy

Understand the terms and conditions of your health insurance policy before making a claim. This also includes the covered treatments, exclusions, the process of claiming, and about any deductibles or co-payments. Ensure that the treatment or hospitalisation you are seeking reimbursement for is covered under the policy.

Step 2: Notify Your Insurer

For most health insurance policies, it's crucial to notify your insurer regarding the claim as soon as possible. This usually is done within a specific number of days from admission or treatment. Some insurance companies have a specific time limit (for example, 48 hours for planned admission and 24 hours for emergency cases), so it is best to check the policy for the exact number of days. If you are being treated at a network hospital, the process may be quicker since most of these hospitals work in collaboration with insurance companies.

Step 3: Collect Required Documents

To file a claim, you will require documents like:
●Copy of policy document
●Treatment or bills at the hospital
●Report on your medical condition
●Medical prescriptions
●Discharge summary, if applicable
●The claim form issued by the insurance company
●Every document required by the insurance provider
●All the given documents should be signed with the correct dates and filled

Step 4: Cashless Claim Procedure

When you are getting treatment in a networked hospital, you can request a cashless claim. This means you do not need to pay in advance for the treatment covered. Instead, the hospital will directly bill the insurer, and the insurance company will settle the amount (subject to the terms of your policy). For cashless treatment, you will usually need to present your health insurance card or policy number at the hospital's insurance desk. Be sure to notify your insurer in advance for approval.

Step 5: Reimbursement Claim Process

Generally, this is required in a non-network hospital or if you have paid for the medical expenses in advance. You need to submit your bills and other necessary documents to the insurer. After processing the claim, the insurer pays the amount as per the coverage by subtracting the co-payments or deductibles made during the treatment.

Step 6: Track Your Claim

After you file your claim, your insurer may take a couple of days before processing your claim. Be sure to contact your insurance company from time to time to get updates on your claim. Some companies also have the option to track the claim online.

Step 7: Rejected Appeals

In case of partial or full rejection of your claim, please review the rejection letter to understand the reasons behind the decision. If you feel the rejection was unjustified, you can appeal the decision. You might need to submit additional documents or provide clarifications to support your case.

Step 8: Understand Policy Limits and Waiting Periods

There may be certain limitations on claim amounts or waiting periods before specific treatments or conditions in some health insurance policies. For instance, maternity cover might have a waiting period of 9 to 24 months or pre-existing conditions might not be covered immediately. Thus, awareness of these can help one avoid unexpected surprises during the claims process.

Follow the steps given and you will see a very smooth process in regard to health insurance claims. Always maintain records of communications, receipts, and other documents related to your claim for reference later.