How to Claim Medical Insurance?

Mastering Health Insurance Claims: A Comprehensive Guide

Knowing the right processes for health insurance claims can help you reap the benefits of your insurance when you need it the most. However, for that, you need to have a clear idea of the steps, documents required, and common reasons for rejection. 

This guide covers just that, enabling you to file quick claims, regardless of whether you are opting for cashless treatment at a network hospital or claiming reimbursement. 

Methods to Claim Medical Insurance

There are two main ways in which medical insurance claims can be settled: Cashless or Reimbursement:
Cashless Claims:

●Network Hospitals: When hospitalization is needed, opt for treatment in hospitals that belong to your insurer’s network.
●Pre-Authorization: Notify the hospital’s insurance desk of your policy and complete a pre-authorization form
●Approval: The hospital submits the form to your insurer for approval. Once the claim is approved, the insurer pays the bills directly to the hospital.

Reimbursement Claims:

●Non-Network Hospitals: If you go to a non-network hospital, you must cover the bills upfront.
●Gather Documents: Collect all the required documents, like hospital bills, discharge summaries, and prescriptions.
●Submission: Submit these documents along with a duly filled claim form to your insurer.
●Processing: The insurer then verifies the documents and transfers the admissible amount to your bank account.

Star Health Insurance has both cashless and reimbursement claim options, providing a high level of flexibility to policyholders.
Comparison of Cashless and Reimbursement Claims:

Aspect Cashless Claims Reimbursement Claims

Hospital Network Requires treatment in-network hospitals. Applicable for both network and non-network hospitals.
Payment Process The insurer settles bills directly with the hospital. The policyholder pays upfront and gets reimbursed later.
Pre-Authorization Mandatory before treatment, except in emergencies. Not required, but prior intimation is advisable.
Documentation Minimal, as the hospital coordinates with the insurer. Extensive, including all original bills and reports.
Processing Time Faster, as approvals are obtained before or during hospitalization. Longer, as the insurer reviews documents post-treatment.

What Documents are Required for a Health Insurance Claim?

A well-managed documentation is essential for a smooth claim procedure. Commonly required documents include the following:

●Claim Form: The form should be completed and signed.
●Hospital Bills: Copy of final, itemized bills and payment receipts.
●Discharge Summary: A detailed report of when you are discharged from the hospital.
●Prescriptions: Doctor’s prescriptions for medicines and tests.
●Laboratory Reports: Results of lab tests, such as blood work, X-rays, MRI scans, etc.
●Policy Documents: Health insurance policy copy, ID proof.

Having all the paperwork in order can speed up the claims process.

How to Check the Status of My Health Insurance Claim?

You can check your health insurance claim status via the following methods:

●Through Online Portal: Visit your insurance provider’s official website and go to the claim status page.
●Mobile App: You can check the status of your claim using the insurer’s app.
●Customer Support: Call the insurer’s customer service helpline.
●Email Updates: Certain insurers offer email alerts throughout the claim process.

Star Health Insurance, for instance, provides several channels: its website, app, and a 24/7 customer support helpline for policyholders to easily track the status of their claims.

Common Reasons for Health Insurance Claim Rejection

Check out some of the common reasons which can lead to health insurance claim rejections:

●Documentation Issues: Documents are either missing or incorrect.
●Policy Exclusions: Treatments not covered as per the policy.
●Claims During the Waiting Period: Claiming health insurance for pre-existing diseases, maternity coverage, or specific ailments within the waiting period will lead to rejections. 
●Non-Disclosure: Not declaring any pre-existing conditions when purchasing the policy.
●Delayed Submission: Failing to notify the insurer or filing claims within the required time period.

Understanding these factors and systematically following the claim process can increase the probability of a successful claim. Also, choosing an insurer with a high claim settlement ratio is a must. 

Star Health has an in-house claim settlement team that processes 90% of cashless claims within 2 hours and 92% of reimbursement claims within 7 days. So, if you are looking for a health insurer with a seamless claim settlement process, choosing Star Health can be your best option.   

Get in touch with us today for a customized quote!

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