Claim Payout

The process of settling a health insurance claim and paying the expenses/reimbursement to the policyholder is known as claim payout

• Cashless claim payout: If the patient is admitted in one of the insurance provider’s network hospitals and the medical condition of the patient is covered under the policy, the claim is eligible under cashless payout. In case of emergency hospitalization, the individual needs to inform the insurance company within 48 hours of hospitalization. When hospitalization is planned, the policyholder needs to inform the hospital 3 days prior to hospitalization to enable cashless transactions. The documentation for cashless payout is taken care of by the network hospital, and these claims are settled efficiently.

• Reimbursement claim payout: In case the patient is admitted to a non-network hospital or does not receive the pre-authorization for cashless treatment, the patient is required to pay the hospital and complete the documentation on discharge. The patient then files this documentation with the insurance company, and the company processes the reimbursement. Representatives from the health insurance company, such as the Care Managers at Aditya Birla Health Insurance, are available to assist the individual and his/her family in this process. However, reimbursements can take time in processing, and if the documentation is not filed correctly, there are chances of rejection.