Health Insurance Claims
The health insurance tends to cover overall risk estimation of the health care. This includes test reports, hospital bed charges, food that comes under the health care benefits accordance to the insurance agreement. You can regulate the benefits by your insurance provider.
How Are You Going to Claim for the Health Insurance Policy??
You have to provide cashless card in network hospitals provided by insurance company .
- Submit Insurance ID number provided by your Insurance provider to claims department in hospital.
- Submit a copy of policy.
- Check if the pre-authorization form is sent to Insurance company/TPA by hospital’s claim department.
- Provide other details as per Insurance companies queries for verification and approval.
- In case hospitals ask for claim number, you may call on toll-free number for which you should know your(Policy number, name of person admitted, nature of illness).
- The claim number will be informed to you and insurance claim department of the hospital and further process will be carried out by the hospital professionals in claim department.
In cases like Tonsillitis surgery,appendix removal, Ear surgery or any other planned treatment which can be done after getting approved by insurer/TPA.
- In cases like Tonsillitis surgery,appendix removal, Ear surgery or any other planned treatment which can be done after getting approved by insurer/TPA.
- A copy of policy and ID card in the hospital’s claims department.
- Check if the pre-authorization form and other documents are sent to Insurance company/TPA by hospital’s claim department.
- In few cases reimburse is denied due to terms and condition that fall under claims policy.
There may be some hospitals that may not have the cashless facility. In such cases the Insured/claimant has to make a reimbursement claim. The following procedure is to be followed
- Notify to your Insurance provider.
- Correctly fill the claims form and attach it with original test reports and bills which be submitted to Insurance company.
- Collect all original reports and bills, like( ECG,X-RAY,Blood test reports,MRI,CT scan etc.).
What are the reasons of rejecting claims?
- Insurance company might deny to proceed with claims in case if it doesn’t fall in any exclusions like disease not payable in 1st year/2nd year / pre-existing diseases.
- Pre-existing disease should complete 4 years for any claims.
- Some expenses has to be borne by the claimant, which Insurance company would not pay as per the policy agreement.
What to do if claim is rejected for no-reason?
- Notify this to Insurance company/Third-Party Agent(TPA).
- If there is no response in 15 days then inform about the same to Grievance cell.
- Still no response? Take this to Quasi-Judicial Body or Insurance Ombudsman centre who can help you.
- If all above doesn’t work , then it’s high time to take this matter to court.
Why and when to renew your health insurance policy?
- Advantage of renewing on/before time: For each claim-free year you get some bonus on coming year. The bonus is limited upto 40-50% depending upon Insurance company.
- Disadvantage of not renewing on/before time: If you don’t renew on time you’ll not get any treatment cover for pre-existing disease/illness which you registered. It will be considered only after 3-4 years from date of commencement of your health insurance.
- We advice you renew your policy before the expiry date and obtain full benefit on your health insurance policy.
Health insurance claim advice for women?
- Health cover for maternity.
- Health cover for menopause and its effect.
- Prone to bone-related disease like osteoporosis, osteopenia Turf Toe, Paget’s Disease and many more.
- Other critical illness like ovarian cancer, breast cancer, vaginal cancer, cervical cancer, uterine cancer, fallopian tube cancer can prove to be expensive.
What Is The Advantage Of Using A Network Hospital ?
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