How to Make a Health Insurance Claim
Filing a health insurance claim doesn't have to be complicated. Follow our comprehensive guide to ensure a smooth and hassle-free claims process.
1. Types of Health Insurance Claims
A. Cashless Claims
Get treatment at network hospitals without paying upfront. The insurance company settles the bill directly with the hospital.
Key Benefits:
- No upfront payment required
- Faster processing
- Minimal documentation
- Direct settlement with hospital
B. Reimbursement Claims
Pay for the treatment first and then claim reimbursement from the insurance company.
When to Use:
- Treatment at non-network hospitals
- Emergency situations
- When cashless facility is unavailable
2. Step-by-Step Claim Process
Cashless Claims Process:
- Pre-Authorization:
- Inform the insurance company 48-72 hours before planned hospitalization
- Submit pre-authorization form at hospital's insurance desk
- Provide health card and ID proof
- During Hospitalization:
- Keep all medical documents safe
- Inform insurance company about any additional procedures
- Get updates on claim status
- At Discharge:
- Review the final bill
- Sign necessary documents
- Pay for non-medical expenses
Reimbursement Claims Process:
- Initial Notification:
- Inform insurance company within 24-48 hours of hospitalization
- Get claim reference number
- Document Collection:
- Original bills and receipts
- Discharge summary
- Investigation reports
- Doctor's prescriptions
- FIR/MLC in case of accidents
- Claim Submission:
- Fill claim form completely
- Attach all required documents
- Submit within specified timeframe
Important Tips for Successful Claims
- Keep copies of all submitted documents
- Follow up regularly on claim status
- Submit additional documents promptly if requested
- Note down claim reference numbers
- Read policy documents carefully for exclusions