how to submit health insurance claims
Health Insurance

How to File a Health Insurance Claim?

With the rising medical expenses and changing lifestyles, it has become imperative to purchase a comprehensive health insurance plan in today‘s time. Additionally, the recent COVID-19 pandemic has further established the importance of health insurance even firmly. A health insurance policy is the finest way to receive the best medical treatment without burning a hole in your pocket.

Be it an unforeseen medical emergency or a planned treatment, a health insurance policy can always come to your rescue. However, to avoid any last-minute hassle, you must be well aware of the process to file a health insurance claim beforehand. Below is a quick guide on how to file a health insurance claim.

But firstly, let‘s understand what a health insurance claim is.

Health Insurance Claim

A health insurance claim is a request that a policyholder must submit to the insurer for getting the services that are covered in their health insurance policy. Depending upon their convenience, policyholders can either opt for a cashless claim settlement option or reimbursement for the availed medical services.

Cashless Claims

For cashless claims, the insurance provider settles the hospitalization bills directly with the hospital. However, to get the benefits of a cashless claim, the policyholder should be hospitalized only at a network hospital of the insurer.

Reimbursement Claim

In case of reimbursement claims, the policyholder pays for the hospitalization expenses and later requests for reimbursement by the insurance company. The reimbursement facility can be availed at both network and non-network hospitals.

Now that you are well aware of the types of health insurance claims, let‘s understand how to file a health insurance claim

How to File a Health Insurance Claim?

1. Get in touch with the insurance help desk at the hospital

2. Show the ID card of the insured provided by the insurance company

3. The hospital will verify the insured‘s identity and will submit the pre-authorization form to the insurance company

4. The insurance company will then review all the documents submitted and process the claim as per the terms and conditions of the health insurance policy.

5. For reimbursement claims, you will also have to submit original bills to the insurance provider. The insurer will then evaluate the claim and make a payment to the insured. In case the treatment is not covered under the health insurance policy, the claim will be rejected.

Make sure that you have the following documents readily available with you before filing a health insurance claim.

Documents Required to Make a Claim

  • Valid photo ID cards such as Aadhaar, PAN, and Driving License

  • Copies of prescription for diagnostic tests, treatment advice, and medical references

  • Original set of investigation reports

  • Original hospital and pharmacy bill

  • Original discharge card or discharge certificate

It‘s always advisable to opt for an insurance company with a high claim settlement ratio and a large number of network hospitals. This makes the claim settlement process completely hassle-free.

Frequently Asked Questions (FAQs)

1. When can my health insurance claim be rejected?

Your claim can be rejected if you file a claim for an ailment that isn‘t covered by your health insurance policy. Moreover, your claim can also be rejected if you fail to submit the necessary documents or file a claim during the waiting period

2. What is the minimum time limit for hospitalization to make a health insurance claim?

You can file a claim if your hospitalization is for more than 24 hours. However, for certain treatments, such as dialysis, chemotherapy, etc., the stay could be less than 24 hours

3. What is claim settlement ratio?

The claim settlement ratio is the ratio of number of claims paid to the number of claims received

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