Do’s and Don’ts for Filing a Health Insurance Claim

How to Navigate the Health Insurance Claim Process

Health insurance is essential to handle medical emergencies without negatively impacting one’s financial situation. Many individuals are still unsure if they will receive appropriate care during times of emergency hospitalisation, even though they have adequate insurance coverage.

To prevent claims from being rejected and to ensure that insurance claims are processed promptly, it is essential to adhere to the claims settlement procedures as specified by the insurer.

Process of filing a health insurance claim

A health insurance policy allows claims to be made in one of two ways: cashless or by reimbursement. One must receive treatment in the insurer’s network hospitals to submit a cashless claim.

Do’s for filing health insurance claims

Inform the insurer: It’s important to inform the insurer about the diagnosis and the treatment location before being admitted to the hospital or within one day of admission. Patients looking for cashless hospitalisation should seek care at the insurer’s network of hospitals.

Review the insurance’s exclusions criteria: Read the policy’s terms and conditions and understand its inclusion and exclusion requirements. Always do keep a copy of the policy in a secure location, combine the exclusions that are not covered by the insurance, and make the required arrangements to pay for those products.

Recognise the Waiting Period Clause: The waiting period is necessary for some illnesses for which the insurer cannot submit a claim. Depending on the insurance and policy, this varies.

Use the insurance company’s mobile app: Through the insurance’s mobile app, you can inform your insurer or ask about the claim procedure. After registering on the app, you can use the mobile app to display your health insurance card.

Check the co-payment amount: If the costs exceed it, you can only file a claim. You are expected to pay a portion of the costs.
Compare medical insurance: You can compare several health insurance plans side by side while purchasing health insurance online, which is undoubtedly one of the best aspects. This doesn’t need to be done manually. Simply visit the insurance company’s website of any health insurance provider to compare health insurance policies.

Read the policy document: The most important step in purchasing any sort of insurance is to read the policy document entirely. You must be aware of the coverage, exclusions ,and restrictions stated in the policy document, despite the fact that it is full of terms and conditions written with certain complex terms. Additionally, you may contact your insurer if you have any questions regarding the insurance jargon.

Save your documents: You should save all of your hospital bills, reports, pharmacy invoices, diagnostic test results, etc., in the event that you do not file a cashless claim. When submitting the necessary paperwork to the insurance company to file your claim, be sure to do with your originals.

To ensure accuracy, double-check all the data you entered on the claim application form, such as your name, age, policy number, etc. Additionally, make sure the doctor has signed and stamped all the paperwork, collect all the original invoices, and keep the pre- and post-hospitalisation reports that need to be presented to the insurance provider on filing a claim.

Don’ts for filing health insurance claims

Don’t conceal your health status: When you get health insurance, your insurer offers financial protection in the event of a medical emergency. Your claim will be denied if you make a claim while concealing your health conditions that are not covered by the policy. Never conceal your health status or provide incorrect information when purchasing a policy.

Don’t avoid buying additional coverage when needed: If a medical emergency arises, your health insurance policy should provide comprehensive coverage. You should consider must make sure that you buy enough cover if you want to accomplish this. Consider buying extra coverage if you believe your current policy is insufficient. For instance, if your employer’s health insurance policy is insufficient, you could strengthen your coverage by opting for an additional health insurance plan.

Don’t purchase until you are aware of the health insurance plan: if you do not fully comprehend the benefits of a health insurance plan, do not purchase it. It can fall short of your needs, leaving you with inadequate coverage. This is equivalent to forgoing health insurance entirely. When in doubt, always ask for assistance.

Do not refrain from renewing your health insurance: Typically, a health insurance policy lasts for one year before needing to be renewed. Keep in mind that if your coverage has expired, you cannot submit a claim. Therefore, renew your health insurance coverage on time to maintain your financial safety net.

Delay in filing claims: Be sure there are none when you submit your claim to the insurer.

Don’t submit a claim for a hospital stay of less than 24 hours: Do not submit a claim for a hospital stay of fewer than 24 hours unless the hospitalisation is a daycare procedure (please refer to your policy document for further information on the daycare procedures specified and covered under your policy), health insurance does not pay for any hospital stays of less than 24 hours. For a situation like that, you shouldn’t submit a claim. Don’t seek hospitalisation if your treatment doesn’t require it, meaning you can receive it on an outpatient basis.

Conclusion

You can experience a hassle-free insurance claim process by adhering to the above-mentioned dos and don’ts to file a health insurance claim. Prior to being admitted to the hospital, it is essential to take the important steps and precautions when making a health insurance claim.