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Reimbursement Claim Process In Case of Health Insurance



Health Insurance Claim Reimbursement Process


If your insurance does not provide a cashless claim option, or if the hospital is not one of their network hospitals, you will be responsible for paying the medical expenses when you are admitted to the hospital. The medical expenditures will be reimbursed by the insurer afterwards. The following actions must be followed throughout the reimbursement claim process:


Step 1: Double-check the information.


Verify that the information on the bill is correct before signing it. This is crucial since any inconsistency here might have a negative influence on the claim procedure.


Step 2: Gather the paperwork


The following is a complete list of papers that may be required:


Claim form that has been completely filled out and signed - Download Claim Forms

Insurance Card or Insurance Policy? a copy of the doctor's signed medical certificate

X-ray reports, for example, are pathological reports.

Discharge paperwork from the hospital

Original receipts and bills

Pharmacy bills from the beginning

FIR / MLC copy, if any investigation report (in case of an accidental claim)

NEFT Instructions to Credit Settlement of Claims

If the claimed amount exceeds Rs 1 lakh, you must submit a completed CKYC form.

3rd step: Keep an eye out for papers.


Some of the papers indicated above may not be available right away, and you may need to return in a few days to get them.


Step 4: Submit the paperwork


Depending on your insurer's protocol, you can send all of these paperwork to the insurer or the approved TPA as soon as you are released.



Step 5: Wait for your payment to be processed.


The documents will be evaluated once they arrive at the TPA or insurer. From the time the paperwork arrive at the TPA until the time the payment is processed, it takes roughly 21 days.


You will be alerted if the insurer or TPA rejects the claim or has a question about it. Complaints- If you are dissatisfied with our services and wish to file a complaint, please fill out the form below.

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