Making A Claim Under Health Insurance! Keep These Things In Mind

Health insurance plans for family can be made either in reimbursement basis or on a cashless basis. One’s treatment must be only at a network hospital of the Third Party Administrator (TPA) who is servicing your policy for a cashless basis claim. For availing the treatment on a cashless basis, you have to seek authorization as per the procedures laid down in the prescribed form. As soon as you receive the policy documents read it and get yourself familiarized with the process rather than waiting for a claim to arise. To file a claim under reimbursement basis you should inform the insurance company as per the procedures required. Ensure that you obtain and keep the documents ready such as bills that you should submit for a claim, prescriptions, discharge form, claim form etc.

When a health issue crops up, the claim made will depend upon the type of treatment that will be availed by the insurer. The types of treatment offered on buying family health insurance plans are:

· Planned treatment

When the medical treatments are pre-planned, the insured need to inform the insurer 7 days prior to the admission. You need to submit the cashless authorization form. The form is available at the TPA help-desk in the hospital.

· Emergency treatment

During emergency treatment, the insured has to inform the insurer regarding the hospitalization within 24 hours of the admission.

Making a claim comes along with some important tasks:

Timely submission of documents

You need to submit all the required documents within the pre-specified time period. In case of reimbursement claim, you need to submit some crucial documents such as discharge summary, claim form, bills, and prescription. In case of cashless hospitalization, all the paperwork will be taken care of by the hospital insurance and the insurer after intimation.

Keep a note of claim intimation TAT

Timely claim intimation plays an important role in smooth claim settlement. Immediate claim intimation is a very good practice to follow it. In case of emergency treatment, there is a turn around time of 7 days to inform the insurer.  In case of cashless claim settlement, you need to inform the insurer a week before or immediately in cases of pre-planned treatment.

Mind the list of exclusion

You need to read the list of exclusion under the health plan carefully before filing a claim. If under the terms of policy the cause of hospitalization is a restriction then your claim will get rejected immediately.

Tips for ensuring a smooth claim settlement

· Always try to maintain and collect proper records of your medical report while making a claim under family insurance plans.

· Always collect the original bills, discharge summary, pharmacy receipt, a copy of investigation report, prescriptions, etc. from the hospital.

· Avail medical treatment in a network hospital in case of cashless claim settlement under family health insurance.

· Keep at least a single copy of all the medical bills and claim papers.

· Disclose all the material information and facts to the insurer while buying health insurance plans for family.

· Know the waiting period, payout limit, and co-payment applicable to the coverage of the policy.

· Ensure timely submission and intimation of the claim documents.

· Share the accurate and complete claim documents with the insurer under family insurance plans.

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Created on Nov 22nd 2018 01:51. Viewed 601 times.

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