The biggest reason for buying health insurance is to get financial help during a health emergency. For this, you have to either claim cashless or reimbursement with your insurance provider. Cashless claims are possible only in the network hospital of your insurer. That’s why when you want to get treatment done in another hospital, you have to claim reimbursement for it. If your insurance company has rejected the cashless claim, then you can file a Reimbursement Claim. In case of a medical emergency, the first step is to file a claim with your insurance company for financial help. If you cannot make a cashless claim, then Reimbursement Claim can be the best option for you. It is important to read the steps involved in making a Reimbursement Claim carefully. So that you don’t make any mistake. Other than this,
What is the process to file a claim
Give information to the insurance company
Inform your insurance company or TPA about the medical emergency or planned hospitalization. If you are planning to get admitted in the hospital for treatment. So you have to inform your insurer or TPA at least 48 hours before getting admitted. On the other hand, if you have been admitted to the hospital due to any medical emergency, inform your insurer or TPA within 24 hours.
get treatment
Once you inform your insurer, get treated in a hospital and focus on complete recovery. Make full payment of the hospital bill at the time of discharge from the hospital.
Collect documents and fill the form
At the time of discharge from the hospital, get all the medical documents related to your treatment including hospital bills and discharge summary. After discharge, fill the health insurance claim form of your insurance company. This form can be downloaded from the website of the company.
Submit all the documents to the insurance company
You should submit all the necessary documents to your insurance company within 15-30 days. For this you can check your policy document or contact your insurer.
Claim request verification and payment
After this, the insurance company will verify all the documents and cross-check with the coverage available under your health insurance policy. Once the verification is done, your claim is accepted or rejected within 30 days. You are paid after your claim is accepted.
These documents are necessary
To claim reimbursement, fill the form properly, along with photo copy of health card / insurance policy, original test reports like blood test report, X-ray, CT scan etc., photo copy of doctor’s consultation paper and prescription, Original Hospital Discharge Summary, Original Hospital Bill, Original Medicine Bill, Original Bill Payment Receipt, Original Implant Sticker, FIR or Medico-Legal Certificate (MLC), KYC document copy and NEFT details are required.
