The health insurance claim process is generally a request from the policyholder to the insurer to avail of the benefits of having a health insurance policy. The insurer follows some set of instructions to settle the claim. With this, the policyholder can get either cashless treatment or reimbursement of the amount spent on treatment or health services. you have to intimate the insurer as soon as you admitted or started to take the treatment from hospitals in order to make the process smooth.
Types of the health insurance claim
1-(a) Cashless claim settlement method for planned treatment
This settlement is done mainly with the network hospitals your insurer has informed you or mentioned in the card.it means the insurer might be in partnership with hospitals and there you can avail the services freely. You should inform the insurer 3 to 4 days prior visiting the desired hospitals.
Submit the cashless claim request form to the insurance provider though email or through call.
The hospitals and insured will receive an update from the insurer about the coverage, terms and conditions.
On the day of admitting to the hospital, you need to show the insurance card and confirmation letter of your insurer, and you are done. Your claim will be settled directly to the hospitals.
1-(b) Cashless claim settlement method for unplanned treatment
In case of emergency you have to reach the hospital as soon as possible for treatment.in such situations insured must provide a health insurance card in order to get admission into the ER. A cashless claim request form will be sent to the insurer through FAX, Email, and customer care by the hospital who will then approve the coverage details. In this claim medical bills be provided by the insurer as well.
2-Reimburesent claim settlement method
This settlement comes in to picture If you take treatment outside the network of the insurer hospitals.in this process, you have to pay every bill starting from entering hospitals to exiting, also medical bills. Later you can apply to get the bills reimbursed to your insurer. the insurer is liable to pay the entire amount after considering the limits and deductibles opted by you at the time of purchasing the policy.
Documents needed to claim
The below-mentioned documents will help you make the health insurance claim process smooth.
- Claim form filled
- Policy document
- A medical certificate signed by the doctors for the treatment
- Hospitals Discharge summary
- All the original bills
- Valid ID proof
- FIR or medico-legal certificate(MLC) in case of an accident
Medico legal certificate(MLC)
It’s a certificate that is needed when there is a case of an accident or injuries and it has been attended by the doctor. its doctor’s legal responsibility to inform the police if there is any further investigation needed to detect any deceptive means.
Health Insurance claim process will be very easy and convenient if you have all the necessary documents available and you intimate the insurer on time or before.