How to Make Health Insurance Claims During Medical Emergencies?

by Nisha Scott Account manager

If you are planning to purchase health insurance or have already purchased one, you should clearly know how to make a claim in case of an emergency. Read this post to know the basics of submitting an insurance claim.

With the rising healthcare costs in the country, health insurance is now a must for every individual irrespective of their age. If you have purchased health insurance and are admitted to a hospital for some reason, the insurance provider will pay the treatment costs up to the policy coverage as per the terms and conditions of the policy.

But to request direct payment of your hospital bills or reimbursement, you are required to file an insurance claim. Irrespective of whether you are planning to purchase health insurance or already have one, it is essential to thoroughly understand the claim filing process so that you can take maximum advantage of your emergency health insurance.

Types of Health Insurance Claims

Before talking about the claims process, you should know that insurance providers offer cashless and reimbursement facility. If you are admitted at one of the network hospitals of the insurance provider, you can make use of the cashless facility. With this facility, your insurance provider will directly pay your medical expenses to the hospital.

The reimbursement facility for emergency medical insurance is generally available at non-network hospitals. With this facility, you are required to first pay the medical bills and then get the same reimbursed from the insurance provider.

For Cashless Claims

Here are the steps for filing a cashless medical claim at a network hospital of your insurance provider-

●       Flash your health insurance card at the TPA (Third Party Administrator) desk of the hospital

●       Fill the health insurance claim form

●       Take a copy of your health insurance card and submit the same along with the authorisation form at the time of getting admitted at the hospital

●       TPA desk will send the request to your insurance provider for approval

●       Once the insurance provider approves your request, you will be authorised to receive cashless treatment at the hospital

●       Upon completion of treatment, the hospital will take your signature on all the bills before forwarding it to the insurance provider

●       Once the insurance provider approves your cashless claim, you will then be discharged from the hospital

For Reimbursement Claims

If you are admitted at a non-network hospital or if the cashless health claims at a network hospital is not approved for some reason, you can then make use of the reimbursement facility. Follow these steps for the same-

●       Clear the hospital bills as required

●       Collect all the original bills as well as your medical reports while getting discharged from the hospital

●       File a reimbursement claim with your insurance provider and submit all the bills and reports

●       The insurance provider will approve your claim, and you will be reimbursed as per the terms and conditions of your policy

Understanding the Claim Filing process

To use your health insurance in the best way possible, it is necessary to know how to claim medical insurance. While the claim filing process is generally the same as mentioned above, there can be minor variations based on the insurance provider you select.

As a result, make sure that you go through the claim filing process of the insurer when selecting health insurance and pick a reputed company which has the simplest claims procedure.

 

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Created on Jun 2nd 2020 12:47. Viewed 456 times.

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