A Health Insurance claim, often referred to as a Medical Insurance claim, is a request for payment of the expenses incurred for treatment. Depending on the type of claim procedure you have chosen, the insurance company, upon verification of the claim, either settles the bills directly with the hospital or reimburses the amount you spent.
Types of Health Insurance Claims
A Health Insurance policy's main goal is to offer financial support when necessary. The following two services must be used in order to promptly obtain money from the insurance company:
1. Cashless Claim
2. Reimbursement
Cashless Claim
The policyholder can receive care at any of the insurance company's network hospitals while filing a cashless claim. The policyholder must provide the cashless health card given by the insurer upon admittance, and the insurer will pay all treatment-related costs directly; there is no need for the policyholder to spend a single rupee. At the time of hospital admission, all you need to do to submit a cashless claim is present your Health Insurance card. Within four hours of being admitted to the network hospital, the majority of insurance carriers approve cashless care.
Cashless Procedure for Planned Admission
From the network of hospitals listed in the insurance document, pick one.
Notify the Third-Party Administrator (TPA) three days prior to admission and provide a membership number.
Obtain a hospital cashless request form.
Send the TPA your application and medical records.
The TPA will examine each paper.
Once authorised, the insurance provider will pay the hospital bills only, not including phone, food, or attendant fees.
If not accepted, one may request reimbursement.
Cashless Procedure for Emergency Admission
Inform the Third-Party Administrator (TPA) and submit your membership number in the event of an emergency admission.
In the hospital, complete the cashless form with a doctor's certification.
Send your medical records and the form to TPA.
Any approved cashless facility will immediately pay all medical bills in full.
In the event of rejection, ask for a refund.
Reimbursement
You must first pay for the therapy before submitting a claim for reimbursement in a reimbursement claim. When you submit a claim, you must present the hospital and medical expense receipts as well as other supporting documentation. After reviewing the invoices, the insurance provider will deposit the funds into your bank account.
If your cashless claim request is turned down or if you or a member of your family needs medical care at a non-network facility, you have the option of requesting reimbursement. Recall to begin the reimbursement procedure seven days after the patient has been released.
Reimbursement procedure for a claim
Call your insurance company at the toll-free number and present them with your membership number.
Pay off all hospital debts.
When you ask for compensation, be sure to provide all essential documentation, including bills, prescriptions, discharge summaries, and more.
On the insurance website, you can download and complete the refund form.
Send the form and the medical records to the insurance company.
A check will be produced once the claim has been approved. Once all of the paperwork has been submitted, the procedure normally takes 20 days to finish.
Conclusion
Follow these guidelines closely to make sure your Medical Insurance claim is approved. Keep in mind that the insurance company may ask for any paperwork at any time, so keep them all ready.
