Claiming Health Insurance Benefits

Whenever you or any of your family members or dependents are admitted to the hospital due to an illness or an unfortunate accident, then health insurance provides adequate financial cover. Policyholders can claim health insurance either through cashless mode or in some situations, the policyholder may have to pay all the outstanding amount in the hospital and then the claim is submitted to the insurance company.

You can do this in two ways under the claim of a health insurance policy –

1. The Medical Service Provider can directly deposit the claim from the insurance company. When a person takes a cashless health plan, he should show his ID card so that the third party administrator can help you with the claim. TPA helps you in doing the claim and paying the correct bill in the event of critical illness.

 

2. If your hospital is not in your health insurance company’s network and cannot file a claim on your behalf, you will have to file a health insurance claim form to request for the payment. All the necessary documents should be presented to the insurance company for compensation within 30 days of leaving the hospital.

To claim the insurance, you have to take care of certain things:

• The form of claiming should be filled properly. It is important to keep in mind that your signature is properly done.
• Before leaving the hospital, taking discharge summary, a copy of the inquiry report, and receipt of a bill, prescription and pharmacy reports are important.
• It is important for the doctor to show the certificate for what type of operation has been done and how it is being taken. At the same time, the person should be shown his bill, receipt and the identity card of the disease.
• In addition to the accident, chronic disease is also shown in any situation.
• When submitting the claim, you should submit fresh bank mandate with the details of the policyholder’s bank account and IFSC.
• If your insurance plan does not cover the disease that has happened to you then it may also be that in some cases your claim is considered “no”. But if your claim is not considered, then keep in mind that you file a complaint with your insurance company within 15 days. You should contact your TPA for partial payment.

Medimanage Health Insurance Brokers guide clients through every step to avoid any sort of confusion of choosing policy which is best for them by providing unbiased solutions.