Types of Health Insurance Claims You Should Know About

Types of Health Insurance Claims

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The rising healthcare cost and the increasing incidences of diseases in the population is an alarming situations. Consequently, people need to take measures to safeguard their health and plan ahead for any treatment expense that can crop up. Unforeseen health conditions and medical care costs can bring a toll on your finances if you don’t have a solution arranged in advance.  To combat an unexpected medical situation without any worry, you can stay well-prepared by taking health insurance or a mediclaim policy, which will be a saviour during those tough times.

When a medical emergency strikes, you can raise a request with the insurance provider to avail of the monetary benefits and facilities covered under his plan. By sending a request to the insurer, you can file a health insurance claim. You should be aware of the types of health insurance claims and their procedures to avoid last-minute hassle when making submissions for the claim.

Cashless Claim in Health Insurance

In a cashless claim, the insurance company will pay for the medical bills that you have incurred while getting treatment at a network hospital.  Thus, you do not have to pay for medical expenses from your pocket. A cashless claim can be made for both planned as well emergency hospital admissions but it has to be noted that such a facility generally can only be availed at a healthcare centre that has tie-ups with the insurance company. However, ICICI Lombard also provides an Anywhere Cashless hospitalisation service which allows customers to avail cashless hospitalisation in any hospital of their choice if they inform 24 hours before the hospitalisation. In other cases, the customer can opt for a hospital from the list of network hospitals that is displayed on the insurer’s website. When you plan to purchase a mediclaim policy, look for insurance companies that have a wide network of hospitals. Purchasing a policy from such an insurer will be beneficial as you won’t have a hard time finding the healthcare centres having tie-up with your insurance provider.

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A cashless claim is beneficial for individuals who may not have the financial capacity to arrange the money required to pay for the medical costs all at once.

Cashless Health Insurance Claim Process

  • For planned hospitalisation, the policyholder has to inform the insurer typically 48 to 72 hours before the admission. If it is an emergency hospitalisation, intimate the insurance company within 24 hours of being admitted at the healthcare facility.
  • Locate a network hospital to seek treatment
  • During the time of hospital admission, provide your cashless card, policy number and any other relevant documents as per the requirement.
  • Fill out the pre-authorisation form and hand it over to the third-party administrator (TPA), who is the mediator between the hospital and your insurer. They will submit it to the insurance provider.
  • The insurance provider will verify the details and inform the hospital about their approval or rejection.
  • If your claim gets approved, the hospital can send the medical bills to the insurance provider.
  • The insurance company will settle the medical expense based on the terms of your insurance plan.

Reimbursement Claim in Health Insurance

This type of insurance claim allows the policyholder to receive treatment from any healthcare centre, not just the network hospitals listed by the insurance provider. This provides the flexibility of getting admitted to a hospital of your choice. In a reimbursement claim, you will have to pay the medical expense from your pocket while getting discharged and then later apply for compensation of the amount paid with your insurer.

Reimbursement Health Insurance Claim Process

  • Inform your health insurance provider regarding the hospitalisation: For planned and emergency hospital admissions, you must notify the insurer within the stipulated period for each case.
  • You have to pay for all the medical expenses incurred out of your pocket. Keep the bills with you.
  • Submit your health invoices along with the insurance claim form and relevant supporting documents, including the doctor’s prescriptions to the insurance company.
  • The insurance provider will verify your claim details and the medical bills and decides on it. The document verification may take 2 to 4 weeks, depending on the insurer.
  • After document examination, based on the terms of your insurance plan and the demand you made, the claim will either be accepted or rejected.
  • Once your claim gets accepted, the claim amount will be reimbursed.
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How to Make a Successful Health Insurance Claim?

Follow these tips to make sure that your claim for health insurance gets approved by the insurance provider.

  • Carefully fill out the health insurance application form. Don’t make any mistakes.
  • Don’t conceal any details and disclose your previous and present medical history during the time of purchasing the insurance policy to avoid any issues when filing a claim later.
  • Inform the insurance provider about the claim at the earliest.
  • Follow the rules and conditions stated in the insurance plan while applying for the claim
  • Fill out the settlement form without any errors.
  • Submit the original bills and all necessary documents that support your claim

Why You Should Have a Health Insurance Policy?

There are several types of health insurance categorised according to their customisable features and you can purchase one that suits your needs. There are insurance policies that cover a single person, called individual health insurance plan and a family health insurance plan that secures the all members of a family under a single coverage. Having a health insurance plan or a mediclaim policy for yourself or the entire family members is essential to navigating a period of hefty financial need arising out of medical emergencies. It will provide you with financial assistance for all kinds of medical care, including modern and alternative treatments and tax benefits and help deal with medical inflation.

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