subject: Make Your Health Insurance Claims Hassle Free [print this page] Many times, we find people complaining about health insurance companies. They complain about all the hassles and paperwork and yet find their claims unsettled. The problem is that many of us buy health insurance policies in March to get a tax advantage, or to oblige friends and relatives who are agents. Very few people realize the importance of a health insurance policy and have the knowledge to make a policy work to their advantage.
Understanding the health insurance claims process
But knowing and understanding the medical insurance policy is only part of the story. It is also important to understand the claims and settlement process. You should understand the role of third party administrators (TPAs), documents that may be needed, policy documents, cashless card etc.
Here are a few tips to help you understand the processes involved in making health insurance claims:
A) Hospitalization in Network Hospitals
Every health insurance company has a list of paneled hospitals across India. You can avail of cashless hospitalization at any of the hospitals in the panel. To avail the cashless facility at these hospitals, you have to go through the TPA. It is the TPA that authorizes cashless service at the empaneled hospital.
Inform your TPA as soon as possible (the contact number for the TPA will be mentioned in the policy or available on the respective insurer's website). Coordinate with the hospital to have the details sent to the TPA for authorizing the cashless service.
On discharge, verify and sign the bills and pay for the items that are not payable under the health insurance policy (the policy document contains all the details about the expenses that are covered and those that are not covered).
The original discharge summary and other investigation reports should be handed over to the hospital. Retain a photocopy for your records.
In case of a planned hospitalization, coordinate with the hospital and send in all the details of your hospitalization (including the plan of treatment, cost estimates etc) to the TPA at least three days prior to admission. Also indicate the contact details of the hospital to send the authorization.
B) Hospitalization in Non-Network Hospitals
Inform the TPA about the hospitalization as soon as possible. At the time of discharge, settle the hospital dues in full and collect all the bills, documents and reports. Register your claim with the TPA for processing and reimbursement.
How to lodge your health insurance claim with the TPA for processing and reimbursement
Register your medical insurance claim with the TPA within seven days of discharge. Send the documents listed below for processing your health insurance claim:
Duly signed claim form
Identity proof
Copy of policy document
All hospital bills in original with detailed breakup for consolidated amounts
Bills for medicines purchased from outside should be accompanied by a doctors prescription
Original discharge summary / discharge card
All original investigation reports
You may need additional documents depending on the nature of the health insurance claim lodged. For your records, Retain a copy of the documents sent
Most important, remember that a delay in intimation of claims may lead to their rejection.
If you take care of these, you will not face too many hassles while settling a health insurance claim.
by: Mukesh Kumar
welcome to Insurances.net (https://www.insurances.net)
