How to Get a Health Insurance Claim in Hospital | Guide

How to Make a Health Insurance Claim in Hospitals: Effective Guide

There are several considerations that you need to check for claiming health insurance in a hospital. Firstly, there are two separate ways to claim a health insurance policy, one is on a cashless basis, and the other is on a reimbursement basis. 

However, the specifics of health insurance in hospitals depend on the way your healthcare providers work. Let us examine each of these methods and their effectiveness in obtaining health insurance.

On a Cashless Basis 

If you are planning to obtain health care assistance on a cashless basis, it must be obtained from a network hospital only. At the least, sourcing a third-party administrator helps you even out the difference. 

There can be an elaborate format for the application that the network hospital is going to help obtain and make sure you are filling in the details properly. However, there are some health insurance providers as well who can easily gather your details directly and work without the need for any TPAs. 

Claims on Reimbursement Basis 

This is another way of claiming your health insurance coverage that helps you gather the costs of health insurance seamlessly and ensure cash disbursement. In this strategy, there are several documents involved for reimbursing the amount that the healthcare provider asks for. 

When a claim arises, one must inform the company of the procedure required as well. Post-hospitalisation, you need to have your documents ready, along with the discharge summary and prescriptions, and place your claims. 

Reimbursement Claim Process for Non-Network Hospitals

If you are treated at a non-network hospital, you will need to pay the bills upfront and then claim reimbursement from your insurer. Here are the important steps to follow:

Step 1: Collect Documents

Gather all original documents from the hospital, including the discharge summary, bills, receipts, diagnostic reports, and doctor’s prescriptions.

Step 2: Claim Form

• Complete the health insurance claim form provided by your insurer. Attach all necessary documents.

Step 2: Submission

Submit the completed form and documents to your insurer within the stipulated time frame (usually 7 to 15 days from the date of discharge).

Step 4: Claim Processing

The insurer reviews the claim documents and processes the reimbursement. This may involve additional verification or clarification. Once approved, the reimbursement amount is credited to your bank account.

Other Key Points to Consider 

While you are applying for health insurance reimbursements (online/offline), you can ensure a smooth and hassle-free process. Some of the considerations that you need to take are as follows: 

• Understand Your Policy: Familiarise yourself with the health insurance policy and get an idea regarding coverage, exclusions, and claim procedures. 
• Keep Copies: Maintain copies of all submitted documents for your records. 
• Timely Notification: Inform your insurance provider promptly in case of hospitalisation. 
• Co-Payments: Be aware that co-payments might be required for out-of-the-network services. There are certain conditions, like treatments, which are at higher costs, like in tier 1 cities. 

Staying informed allows you to make a hassle-free process when claiming health insurance in a hospital. Remember, early communication with your insurer and thorough documentation are key to a successful claim.

Also Read:

→ Health Insurance Card Renewal Process

→ Health Insurance Policy Cancellation Process

→ Health Insurance Setup for Small Businesses

→ Health Insurance Tax Exemptions Explained

→ How does Health Insurance Work in India