Guidelines for Successful Health Insurance Claim

Today, a health insurance policy is not a choice but a necessity for all. Over the past few years, from the usual daycare treatment to diagnostic tests, the medical expenses have increased significantly. In such a scenario, a healthcare policy plays a vital role in helping you get the best medical care without depleting your hard-earned savings.While buying a health insurance policy is easy, several people face challenges while filing their claim and get compensation for the expenses incurred. When you file for a claim, the insurer pays the amount after assessing your request and verifying the costs. So, if you are not sure how to file a, health insurance claim the following tips will help you.

• You can avail of a cashless settlement facility if you seek treatment at any of the network hospitals. Here, the TPA (Third Party Administrator) and the insurance company settle the bill directly with the hospital; you need not pay a single Rupee from your pocket.
• The first step in filing a cashless claim is to inform the TPA about the hospitalisation and the treatment facilities availed as soon as you get admitted to the hospital.
• You must contact the TPA to understand the claim process and initiate the claim filing process; the TPAs work as a link between you and the insurance company.
• After you get discharged from the hospital, you must submit the relevant bills and other medical expenses-related documents to the TPA. Once your claim request is reviewed against the policy terms and conditions, the insurer will settle the bill with the hospital.
• If the insurer denies the cashless claim for some reason, you must pay the bills from your pocket and apply for a reimbursement.

• In case of a medical emergency, if you seek treatment from a non-network hospital, then you must pay the expenses initially from your pocket and file for reimbursement.
• In the case of planned hospitalisation, you must inform the insurer about hospitalisation and the type of treatments availed.
• You must get in touch with the TPA to help you start the claim process.
• Submit the relevant documents (bills, receipts, doctor’s letter) to support the health insurance claim amount. The insurer will then review the claim against the policy’s terms and conditions and inform you of their decision.
• If the claim is accepted, the insurer will pay the approved amount and issue a claim settlement letter providing details of the breakup amount.
• If the claim is rejected, the insurer will send you the rejection letter stating the reason.

Every insurance company has a time limit for different processes; ensure that you strictly abide by the timelines for successful claim settlement.Before you sign the policy documents, understand the terms and conditions and know what is included and excluded in your plan to avoid filing for a false claim.Always keep your hospital-related and insurance-related documents safe and handy for hassle-free claim filing.

The information contained herein is generic in nature and is meant for educational purposes only. Nothing here is to be construed as an investment or financial or taxation advice nor to be considered as an invitation or solicitation or advertisement for any financial product. Readers are advised to exercise discretion and should seek independent professional advice prior to making any investment decision in relation to any financial product. Aditya Birla Capital Group is not liable for any decision arising out of the use of this information.