How To Make Claims With Your Health Insurance Provider?

In times of medical need, your health insurance provider can be your financial safeguard, covering all expenses. When you seek medical care, you often rely on your insurance plan to handle the costs. Whether it’s a hospital visit or a diagnosis, your insurance provider can help you out of the situation hassle-free. However, understanding how to navigate the claims process is pivotal. For those who don’t know how the claim process works in Health Insurance, here is an elaborate guide.

What are the Types of Health Insurance Claims?

The core aim of a health insurance policy is to offer financial support when needed. To receive timely compensation from the insurer, you can use any of the following types of claims.

Cashless Claim

Cashless claims allow policyholders to receive treatment from hospitals affiliated with the insurance company. After admission, the policyholder must produce the health card given by the insurer and the insurance provider immediately takes responsibility for paying the treatment charges (for which you don’t have to pay a single penny). So, at the time of admission to the hospital, provide your health insurance card for a cashless claim. Several insurance companies permit cashless treatment within 24 hours of getting admitted to the network hospitals.

You can request cashless treatment in either of the two following ways.

Cashless Process for Emergencies

If the insurance company approves of a healthcare facility, hospital expenses will be paid immediately.
Notify a TPA (third-party administrator) in the event of an emergency and submit a membership number.
In the event of disapproval, seek reimbursement.
The hospital will provide you a cashless format; fill that out, and get it verified by the doctor.
Together with the medical records, the paperwork must be sent to the TPA.

Cashless Process for Scheduled Admission

Select a hospital from the association as specified in the network paperwork.
Inform the TPA three days before admittance and submit the membership number.
At the hospital, fill in the cashless claim format.
Submit the paperwork along with medical records to the third-party administrator.
TPA will review the entire documentation, and once it is approved, the insurance provider will pay hospital fees, excluding attendant, phone, and meal expenses.
Apply for a reimbursement if this gets disapproved.

Reimbursement Claims

For a reimbursement claim, you need to pay for the medical care first and then make a request for the claim. When you file for the claim, include bills and other relevant monetary documents spent on treatment and hospitalization. After validating the expenses, the insurance provider will reimburse the bank account.

If you or your family member seeks treatment from a non-network hospital or are denied the reimbursement claim, you may file for reimbursement. However, you must apply for the claim within 7 days of the patient’s discharge. The process is as follows:

Contact your health insurance company and provide them with your membership number.
Pay all hospital expenses.
When requesting reimbursement, include medications, bills, discharge reports, and any other relevant documents.
Fill in the reimbursement form available on the insurance company’s website.
Along with the medical records, submit the paperwork to the insurance provider.
You will get a cheque after the claim is approved. For this process, the normal turnaround time is 20 days from the day of receiving all the papers.

Conclusion

Requesting a health insurance claim can be difficult if it’s your first time. While some insurance companies can take a long time to process, most of them ensure an easy and fast claim procedure. Moreover, every insurance company, while applying for the claim, wants you to correctly fill out the claim format. Also, every customer must submit the claim form within a given time before the discharge of the patient.

To get fast and easy health insurance claims, buy a policy from CoverYou. It is an IRDAI-registered insurance provider that offers attractive benefits.

The health insurance plans that we offer are customisable according to your needs and medical history.
We provide ambulatory services for air, road, and domestic purposes.
With our health insurance plans, you can meet the expenses of all day care treatment.
You can get claim assistance 24/7.

With the collaboration of over 50 medical associations, CoverYou has turned out to be the most trustworthy insurance broker. With our sought-after health insurance plans, individuals and families don’t have to worry about their medical and hospital expenses in India and worldwide.