How To Make Cashless Insurance Claim

With the increasing risk of diseases and the costs of healthcare services heading upwards, many people are looking to protect themselves with a health insurance plan . For the policy-holder, the ultimate payback is when the claim is accepted. Many people get overwhelmed at the time of raising a claim. Let us understand how health insurance claims are processed.

In a cashless policy, the insurance company directly settles the bill with the healthcare institution, that is empanelled itself with the insurance company.

• Check if the concerned hospital is part of the hospital network that is empanelled with the insurance provider.
• Ensure that the particular illness for which the insured individual is admitted for treatment is covered by the hospital.
• If yes, then the individual can exercise the option of cashless treatment after producing all requisite policy-related documents (e-card, any other physical copy).
• Once the patient is discharged, the insurance company shall foot the bill after verifying the same.
• In case the claim gets rejected, the insurance company shall intimae the policyholder in writing, along with reasons for rejection.

These are the general guidelines in a cashless health insurance policy . However, the claims process depends on the type of treatment- whether it was planned or unplanned.

• The insurance provider must be alerted at least 4 days in advance in advance, before the commencement of the treatment.
• A duly filled cashless claim request form must be submitted to the insurance provider.
• The insurance company shall review the request and the policy and intimate the person of the policy cover and eligibility to raise a claim.

1. Planned Treatment - Planned hospitalization is when a person has enough time to deliberate and select a hospital before getting admitted. Here, one must bear the following details in mind:
2. Unplanned Treatment - Unplanned hospitalization arises in the event of an unforeseen emergency. In such a situation, the policyholder can touch base with the insurance company through its customer care department to know more about the network of empanelled hospitals.

A duly filled cashless claim request form must be submitted to the insurance provider. The insurance provider shall in turn issue an authorization letter to the hospital indicating the policy coverage.

When insurance companies receive a claim under a cashless health insurance plan , there are various grounds that could cause rejection. Each step of the claim settlement process is crucial and needs to be executed with utmost caution and consideration. In Conclusion Many people find the claim settlement process complicated and difficult to comprehend. Therefore, it is important to understand the claim process to ensure a seamless and hassle-free experience.

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.