Complete Guide on Health Insurance Claim Process

When a policyholder is admitted to the hospital or is confronted with a medical emergency that requires a lump-sum payment, a health insurance policy contributes. If the medical expenditures are covered by the Health Insurance Plan, a Health Insurance Claim is said to occur at that moment. In the case of a medical emergency, a Health Insurance Claim reimburses the insured for medical expenditures.

The claim is paid without the use of cash whenever a policyholder receives care at a networked hospital. The Insurance Company pays the hospital right away if the medical treatments are performed at a networked hospital. A Reimbursement Claim occurs when the insured pays his or her own medical expenditures and then obtains reimbursement from the insurance company.

The following are the steps to getting a cashless claim settlement:

If you want to seek treatment, notify your insurance company ahead of time. Before being admitted to the hospital, you should provide at least 3 to 4 days' notice. It is necessary to fill out and submit pre-authorization papers to the insurance company.

If the policyholder is taken to the hospital due to a medical emergency, the Insurance Company should be alerted right once, and the pre-authorization documentation should be given within 24 hours of admission.

Once the pre-authorization form is submitted, the Insurance Company examines the request and allows cashless claim payments.

The insured may then obtain the services they need without having to pay for them.

All medical bills, reports, and other medical paperwork should be sent to the insurance company.

If there are additional expenditures that are being covered, original written verification of such charges should also be given to the Insurance Company.

Health Insurance Claim Reimbursement

The following are the stages to obtaining a pre-paid claim settlement:

To get treatment, the policyholder must be admitted to a hospital that is not connected with the Insurance Company.

All official medical records and receipts should be kept by the insured. Medical expenses should be covered by the insured as well.

After being released, the policyholder should get a Discharge Certificate from the hospital where treatment was obtained.

This Discharge Certificate, together with a fully filled Claim Form, original medical reports and invoices, and any other necessary documentation that the Insurance Company requires, should be sent to the Insurance Company.

The Insurance Company must next investigate the claim, the supporting evidence, and any further charges. The funds would be returned after that.