Health Insurance | How To Claim Health Insurance?
Buying insurance is like one side of the story while filing a claim is another. Claiming benefits can be tricky so you are required to be smart and careful while filing for health insurance claim.
For Planned Hospitalization,contact the TPA for your health Insurance Policy and inform them about the planned hospitalization. Verify the coverage terms of your policy and ensure that the Hospital / Medical facility where you are planning to get treated is in the Insurance company’s Network. In case the hospital is not in the network find out the costs that will be covered. If your Insurance company offers cash-less facility then ask the TPA about the process to follow.
In case of an Unplanned Hospitalization inform the TPA as soon as possible to get the Claim forms and understand the procedures to file the claim. Make sure that your claim form and all other supporting documents are filed within 7 days of completion of treatment.
On completion of treatmentget all the necessary documentation from the hospital and surgeon. You will have to settle the bills out of your pocket and get reimbursed by your Insurance company later. Complete the Claim form and all supporting documentation and send it to the TPA.
However, while filing claim you have to keep certain things in mind some of it are listed below:
Claim form to be duly filled and signed by claimant.Discharge Certificate from the hospital to be attached with all other documents pertaining to the illness right from the start date it was detected i.e. Doctor’s consultation reports/history.All Bills, Receipts, Cash Memos received from hospital supporting the illness.Diagnostic test report supported by a note from the attending medical practitioner/surgeon.Certificate from the attending doctor stating the nature of the operation performed, bill and receipt. Attending consultants / specialists / anesthetist’s bill and receipt.Certificate from the attending doctor that the patient is fully cured.
In certain cases your claim maybe rejected if the treatment is not covered by your insurance policy. If your claim is denied make sure you write to the Insurance company within 15 days and lodge a complaint. In case of partial payments, check with your TPA for the reasons. In most cases providing additional documentation might help recover the rest of your claim.
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