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How can I get the claim in health insurance?

Under health insurance, you can get the claim amount in two forms -cashless and reimbursement. For both cases, the first step is to inform the insurance company about the same as early as possible. In case of cashless, you don't have to pay anything from your pocket. Once you get hospitalized you must contact the insurance company’s representative who will be present at the hospital only and inform him/her about the scenario. Then he/she will take care of the rest until you get the adequate treatment without paying a single penny. In case of reimbursement, the insured have to pay for all the medical expenses from his/her own pocket and later the company will reimburse the same amount to the policyholder after receiving all the required bills.
Asked by Adhil Shetty on 08 Feb, 2019 in Health Insurance
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Under health insurance, you can get the claim amount in two forms -cashless and reimbursement. For both cases, the first step is to inform the insurance company about the same as early as possible.

In case of cashless, you don't have to pay anything from your pocket. Once you get hospitalized you must contact the insurance company’s representative who will be present at the hospital only and inform him/her about the scenario. Then he/she will take care of the rest until you get the adequate treatment without paying a single penny.

In case of reimbursement, the insured have to pay for all the medical expenses from his/her own pocket and later the company will reimburse the same amount to the policyholder after receiving all the required bills.

08 Feb, 2019
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To get your claims settled by your health insurance provider, there are two pathways-

1. Cashless settlement-

In case there is any planned hospitalization, you can easily claim a cashless settlement at a network hospital by following a simple procedure-

1. Inform the insurer on a call to get guidance. 

2. Submit a completed Pre-Authorization form at the third-party administration counter while admitting the insured person in the hospital. 

3. After this, proper documentation has to be carried out like submission of identity proof and cashless health card provided by your insurer. 

4. The insurer gives you the approval for cashless treatment after analyzing your case and has the right to keep the original documents as evidence of the claim. 

2. Reimbursement settlement-

In this, the insurance provider will reimburse the cost incurred by self on daycare procedures, pre and post hospitalization which are destined to receive compensation under the policy terms and conditions. 

Reimbursement plays a crucial part when cashless claim become ineffective or you avail treatment at non-network hospitals. Check how to claim-

1. Inform the company about the hospitalization and fill the details of the claim in the reimbursement form within 30 days of discharge.

2. Provide the proof of hospitalization necessary like original copies of medical reports, prescriptions bills, hospital bills attached with the form.

3. Submit the discharge summary or card which is issued to the patient at the time of discharge stating that the person is in sound condition.

4. After you complete all the above-mentioned formalities, the process of claim settlement will take 2-3 weeks.

Please Note: Before making a claim it is very mandatory to carefully read and decipher the policy’s terms and conditions. The process for claim settlement may not the same for each and every insurance company. 

08 Feb, 2019
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