Making Cashless Claims On Your Health Insurance – Steps to Follow

  • December 28, 2017

Medical expenses can ruin financial stability of people in India. As per the statistics, it has been revealed that around 63 per cent of people are forced to borrow money. They do it specifically to meet the expenses of medical treatment of their loved ones. Many are also forced to sell their assets for arranging money for the required treatment.

Health insurance with cashless facility will help in this respect. With one in hand, you don’t require running from pillar to post for gathering hard cash. Also there is no need to spend even a rupee from your own pocket. The insurance company will settle the bill with the concerned hospital directly.

Prior to making any cashless claim on health insurance policy, you must have a very clear idea about things that are covered and not covered in your medical insurance policy.

Once a planned hospitalization is summoned, opt for a cashless settlement. When opting for a cashless hospitalization, you must check the main things. Know if the ailment is covered right according to the Terms and Conditions of your health insurance plan. You should also know if the hospital is within the network tie up of the insurer. Hence, a phone call to your insurance company will help before you move ahead with the hospitalization.

When using cashless facility, make sure you intimate about this to the insurance company. You will be asked to fill a Pre-Authorization Form by the hospital during admission. This form is submitted at the TPA (Third Party Administration) counter. From here, the company will further forward the form to the insurer. This is to initiate the cashless approval.

You need to submit documents at the TPA counter. Also submit the Cashless Health Card provided by your insurer combined with some of the requisite KYC documents for identity purpose. The company may take a copy of these documents and return the original documents.

After receiving cashless approval for the claim from the insurer, the original documents concerning hospitalization will be recollected by the insurer.

Don’t forget to check the pre and post hospitalization cover available in your health policy. You may require retaining bills and related medical/prescriptions reports to claim the same. Claim is always done on re-imbursement basis. Referring to the Policy Wordings for timeframes will help.

Re-imbursement Claims – Steps to follow

Some plans do not provide cashless claim facility and you have to reimburse the expenses. Reimbursement may also be sought if you seek treatment in a non-network hospital or if you fail to opt for cashless settlement. Whatever be the scenario, the following steps are to be followed in case of a reimbursement claim:

Step One: Start with informing the company and submitting duly filled reimbursement claim form which is available with the insurer. The information should be given within 30 days from the date of discharge given from the hospital.

Step Two: Now attach all of the original copies of the hospital bills, medicine bills, and medical reports. All of these should be duly stamped and signed with the claim form. Make sure the hospital bill clearly mentions hospital’s Registration No. All reports should clearly mention the patient’s name and date. Attach these along with the prognosis prescription of doctor who advised on hospitalization proving that your medical prescriptions or hospitalization was not voluntary but right according to the advice of your doctor.

Step Three: Post hospital discharge, you will be issued a Discharge Summary/Card that claims you were fit enough to be discharged. You need to submit this card to the insurer.

Step Four: It is time to submit the follow-up prescription in original that shows your fitness post hospitalization. In case of post hospitalization expenses, you must submit the bills within certain period of time (usually 60, 90, or 120 days from discharge). This will depend on the terms of your insurance plan.

Step Five: Make sure you retain the copies of all submitted documents for future reference. Your claim will be settled within two to three weeks once the claim is registered.

Remember that your health insurance plan will prove beneficial only if you are able to successfully claim for your expenses. Following the steps mentioned above will guarantee you of a valid and speedy settlement of all of your health insurance claims.



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