Simple Ways to Make your Health Insurance Claims Hassle Free

Health insurance has become an integral part of one’s life, these days. This is also the reason there has been mushrooming of insurance companies all across the country. With the rise in competition, companies have been vying for customer attention. Unfortunately, this is just the initial attempt by most corporations. Customers are coming up with complaints against these companies under various categories such as customer service, hidden charges, after sales services etc.

Health Insurance

One of the most common of these complaints is the ‘claims process’ related hassles. Many insurance holders feel that despite going through a huge number of hassles and paper-work, the claims remain unsettled for various reasons.

Most people invest in health policies to retrieve tax related benefits in the month of March. Some may even invest in it to oblige their acquaintances, friends and relatives who work as ‘agents’ for health insurance companies.

Unfortunately, there is very little awareness related to benefits of health insurance and only a few of the investors really realize the significance of having a health insurance policy handy. They are ignorant of a health policy can work to one’s advantage.

Possessing a clear understanding of the product is just half the battle won. You must know all about the claim and settlement process. You must also understand the importance of various factors such as the following listed below:

  • TPAs (Third Party Administrator).

  • Various documents required

  • Policy documents

  • Cashless card facilities

  • A lot more

In order to help you get a better understanding of health insurance claims process, listed below are a few tips:

  1. Hospitalization in Network Hospitals

Each insurance company in India has a list of panelled hospitals. These are spread all over the country. A health insurance policy holder can avail the facility of cashless hospitalization that can be availed at any of the hospitals in the panel.

In order to avail the cashless facility at these hospitals, one requires going through the TPA (Third Party Administrator). The role of TPA is to authorize “Cashless Service” at the empanelled hospitals under all of the circumstances eligible as per the terms and conditions of insurance policy.

It is crucial to inform the TPA about health emergency as soon as possible. Every insurance company has a special contact number for the TPA which is mentioned in the policy. It is also available on the official website of the insurer. Also coordinate with the hospital to get the details of bills and treatment methods sent to TPA for cashless service authorization.

Once the patient is discharged, you need to verify and sign the bills. You also require pay for the treatment and items not payable under the health policy. These details are available on policy document. Going through this document will help you get detailed information on expenses covered and those not covered in the policy.

To ensure hassle free claim reimbursement, it is crucial to submit the original discharge summary in conjunction with other investigation reports to the hospital. Also keep a photocopy of these details for your records.

In the event of a planned hospitalization, you must coordinate with the hospital and then send in hospitalization details at least 3 days prior to the admission. These details include the plan of treatment, cost estimates etc. You need to submit these details to TPA. It is important to include contact details of the hospital in order to send the authorization.

  1. Hospitalization in Non-Network Hospitals

The hospitalization matter should be informed to the TPA as soon as possible. And during the time of patient discharge, you must settle the hospital bills in full. Make sure you collect all the bills, hospital reports, and documents. Also register your claim with TPA for processing and reimbursement of insurance cover amount.

The Claim Lodge Process with TPA for Processing and Reimbursement

Here isa process you need to go through in order to lodge a claim successfully:

Register

First and foremost, you must register your claim with TPA within 7 days of discharge. Also send the documents listed below for facilitation of claim processing:

  • Identity proof

  • Duly signed claim form

  • Discharge summary / Discharge card in original

  • Copy of Policy Document

  • All hospital bills in original with detailed breakup for consolidated amounts

  • Bills for medicines purchased from outside, should be accompanied with a doctor’s prescription

  • All investigation reports in original

  • Documents over and above those mentioned above may be called for conditional on the nature of claim lodged.

Keep a Copy

It is crucial to keep a copy of the documents sent for your records.

No Delay

Most important of all, you must remember that any delay in intimation of claim. This may lead to rejection of claim.

If you wish to ensure hassle free claim settlement without any delay or possibility for rejection, simply take care of all the above listed points. Good Luck!

Filed in: Featured, Health Insurance Tags: ,

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