How to Make Health Insurance Claim?

How to Make Health Insurance Claim?

How important health insurance is cannot be stressed enough. It is one of the most profitable financial decisions you may make in your life. You never know what can happen in life. What that phrase exactly means can differ from situation to situation. It represents the idea of uncertainty if life. While it can also mean something good, it can mean you getting into a situation you are unprepared for.

The best way to be prepared for everything related to health is buying health insurance. Moreover, you need to know how to navigate it once you have purchased it. While having health insurance makes sure that you’re financially covered for medical treatment, it involves action from your side as well. As simple as it may sound, making a health insurance claim can have its complications.

For example, timing is of key importance while filing a claim. However, it is also important to follow the process. To do that, you need to know every part of the process. Here is a look into how you can make a health insurance claim:

Filing a Claim

The exact process of making claims depending on the nature of the emergency and the type of claim.

Types of Emergencies

Planned Hospitalization

Sometimes, when you consult a doctor and they instruct you to undergo hospitalization. Or sometimes, doctors inform you that you need to undergo certain procedures before they can continue further.  Both of these case show that hospitalization is planned and a response to a medical emergency. Under such circumstances, you may have to inform your insurance provider before being hospitalized. However, how early you should contact your insurance is different for different insurance providers.

If you are taking admission into a network hospital, you will need to submit a cashless claim form. This can be done physically or through digital mediums. As soon as you notify the insurance provider and the form is submitted, the process going forward are managed by the hospital and the insurance provider. All you have to do as a policy holder is provide the necessary documents at the hospital the time of admission.

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Emergency Hospitalization

Illnesses and injuries are often a surprise. Even in the case of the illnesses that you know you have, you condition could worsen at any time. Hospitals handle such cases through their emergency response department. However, the question of making a claim in emergency situations still remains.

In such a situation, the first thing to do is to make sure that the insurance provider is informed of the situation. For this, the customer care department of the insurance provider can be contacted. Once you arrive at the hospital, the hospital management have to make sure that a claim form is submitted to the insurance provider. The form is assessed by the healthcare department and they communicate the details of the coverage back to the hospital.

Types of Claim

Cashless Claim

A cashless claim is the one where do not have to pay for any part of the treatment from start to finish. The financial exchange of the treatment is between the hospital and the insurance provider. Firstly, a cashless claim can only be made at a network hospital. The hospital you are getting admission in should be in the network of the Third Party Administrator (TPA) that services your policy. Once you have received the proper authorizations and submitted the necessary forms, your worries are over.

Reimbursement Claim

As the name suggests, a reimbursement claim is the one where you pay for the treatment and then the insurance company reimburses your for it. The exact terms and conditions of this type of claim are written in the policy document.  The first thing to do is to follow the proper procedure of notifying the insurance provider. Keep the insurer updated throughout the hospitalization. Once, your treatment is done and you are discharged, you will have to submit documents like claim form, discharge summary, prescriptions, and other types of bills. Once, these documents are processed, your claim amount will be disbursed.