Health Insurance Claims: What You Need To Know Before Filing One

Health insurance is an essential aspect of financial planning. It protects against unforeseen medical expenses and ensures you and your loved ones receive medical care without financial strain. However, filing a health insurance claim can be daunting, especially if you are not aware of the process and requirements. This blog will discuss what you need to know before filing a health insurance claim in India.

Understanding health insurance claims

A health insurance claim requests reimbursement for medical expenses covered under your health insurance policy. To file a health insurance claim, submit a claim form and all the necessary documents to your insurance company. The insurance company will review your claim and reimburse the eligible medical expenses.

Types of Health Insurance Claims

There are two kinds of health insurance claims:

1. Cashless Claims: Cashless claims allow you to receive medical treatment without paying anything out of pocket. In cashless claims, the insurance company directly settles the medical bills with the hospital. Cashless claims are only available at network hospitals, which are hospitals that have a tie-up with your insurance company.
2. Reimbursement Claims: Reimbursement claims require you to pay the medical bills out of pocket and then submit the bills along with the claim form to your insurance company. The insurance company will review your claim and reimburse the eligible medical expenses.

Documents Required for Health Insurance Claims

To file a health insurance claim, you need to submit the following documents:

1. Claim form: You need to fill out the claim form provided by your insurance company. The claim form includes details about the medical treatment and bills.
2. Medical bills: You need to submit the original medical bills that show the services provided, the services’ cost, and the service date. Make sure that the medical bills are stamped and signed by the hospital.
3. Medical reports: You need to submit the original medical reports that show the diagnosis, treatment received, and duration of hospitalization.
4. Prescription: You must submit the original prescription showing the doctor’s prescribed medicines.
5. Discharge summary: You must submit the original discharge summary showing the hospitalization details, the treatment received, and the discharge date.
6. Any other relevant documents: Depending on the nature of the claim, you may need to submit other relevant documents such as investigation reports, doctor’s certificates, etc.

Tips for filing health Insurance claims

Here are some tips that can help you file a health insurance claim successfully:

1. Familiarize yourself with your health insurance policy: Read your health insurance policy carefully and understand the terms and conditions, coverage limits, and exclusions.
2. Keep all the necessary documents handy: Keep all the required documents, such as medical bills, medical reports, discharge summaries, etc., in a safe place to access them easily when you need to file a claim.
3. Inform your insurance company as soon as possible: If you need to file a health insurance claim, inform your insurance company as quickly as possible. Some insurance companies have a time limit for filing claims, so it’s essential to inform them as soon as possible.
4. Understand the claim process: Understand the claim process of your insurance company, such as the mode of claim submission, the time taken for claim settlement, and the documents required for claim submission.
5. Keep a record of all communications: Keep a record of all communications with your insurance company, including emails, phone calls, and letters. This can help you keep track of the status of your claim and any follow-up required.
6. Follow up regularly: It’s best to follow up regularly with your insurance company to ensure your claim is processed promptly.
7. Refrain from submitting false information: Don’t submit incorrect information or documents while filing a claim, as it can lead to claim rejection or even legal action.
8. Take help from a professional: If you need clarification on the claim process or face any difficulties while filing a claim, take help from a professional such as a health insurance agent or a consultant.

Filing a health insurance claim can be complex, but it’s essential to understand the requirements and follow the process carefully to ensure your claim is settled smoothly. Keep all the necessary documents handy, inform your insurance company as soon as possible, and follow up regularly to ensure a timely claim settlement. Remember, health insurance is essential to financial planning, providing financial protection against unforeseen medical expenses.