How to Claim Medical Insurance: Reimbursement vs. Cashless Claims

Due to the surge in the prices of medical expenses, it is important for every individual to get health insurance for themselves and their families.   How to claim health insurance? How to claim medical insurance? How to claim mediclaim?   These are a few questions that every health insurance policy owner must have pondered over in the course of their policy’s life. The process to claim the three are identical.

How to claim health insurance for cashless claims?

Step 1: Pre-inform and check

In case of a planned hospitalization, you need to check with your insurance company if they have a tie up with the hospital where you choose to get your treatment done. You also need to make sure that the insurance company’s terms and conditions cover the ailment that you’re about to get treated.

Step 2: Pre-authorization form

Whenever you want to claim insurance money, it is important to go to the Third-Party Administration desk at the hospital and fill up a pre-authorization form. This form informs your insurance company that you wish to claim on your insurance policy. The hospital will then send the form to the insurer.

Step 3: Documents

After submitting the pre-authorization form, you will be asked to submit your Cashless health card and certain KYC documents for proof of identity at the Third-Party Administration desk.

Step 4: Authorisation Letter

After the insurer receives the form requesting a cashless claim, the insurer will issue an authorization letter to the hospital mentioning whether the claim will be provided or not. In case the claim is rejected, the insured will be notified on their registered mobile number and e-mail ID.

How to claim medical insurance in case of reimbursement claims?

Under the possibility of the insurer not providing cashless claim, or any other reason due to which the insured cannot avail the cashless claim facility, the insured will have to pay the medical bill from their pockets for which the insurer will later reimburse them. In case of reimbursement claims process, the following steps need to be kept in mind:

Step 1: File for reimbursement claim

The insured is required to file for the reimbursement claim with the insurance company within 30 days from the date of discharge from the hospital with the hospital stamp.

Step 2: Documents

The insured is required to collect all the pre and post hospitalization bills and reports for which he is making the claim with the hospital’s stamp. He is required to send these health insurance documents over to the insurance company along with the claim form. The documents need to mention the date of admission, name of the patient, and the doctor’s prescriptions.

Step 3: Discharge form

After the insured is discharged from the hospital, he needs to send the discharge form that he receives from the hospital to the insurance company.

Step 4: Wait for the payment processing

Once all the documents reach the insurer it will take upto 21 days to process and review the documents. If the insurer rejects the claim, the insured will be notified of the same via email and a message on the registered number.

FAQs

Is hospitalization required to make a claim?

Not all claims need hospitalisation, some insurance policies cover dental treatments and doctor’s consultation fees as well.

In spite of having the cashless facility, do I have to make certain payments from my pocket?

Yes, not all charges are reimbursable. These charges that are not reimbursable by the insurance company need to be paid for by the insured from their own pockets. Registration fees, visitor’s admission fee, tv charges, purchase of medicines not related to the insured’s treatments are few of the charges that are not covered under the cashless or even reimbursement facility.

When can one be denied cashless hospitalization?

In case of misinformation or insufficient information sent to Third Party Authorization, or when an ailment isn’t covered under the policy, the insurance company can deny cashless hospitalization.

Conclusion

This article clears all the doubts that one might have about how to claim mediclaim, health insurance or medical insurance. In case of an accident, or an illness one must know how to claim health insurance and its entire process.   *Standard T&C apply Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.