A health insurance claim is a request that a health insurance policyholder submits to the Insurance Company in order to obtain the services that are covered in their health insurance policy. A health insurance policyholder can either get reimbursed or can opt for direct claim settlement option (also known as cashless treatment) for the availed medical services. In this way, one can either submit the claim form or request the health insurance provider cashless services.
Types of Health Insurance Claim
CASHLESS CLAIMS:
In this type of health insurance claim, the insurer settles all the hospitalization bills with the hospital directly. However, an insured needs to be hospitalized only at a network hospital to get the benefit of cashless hospitalization.
REIMBURSEMENT CLAIMS:
In this type of claim process, the policyholder pays for the hospitalization expenses upfront and requests for reimbursement by the insurance provider later. One can get reimbursement facility at both network and non-network hospitals in this case.
Health Insurance Claim Process
Claim Settlement Process for Cashless Claims
The general procedure to avail cashless claim for a health insurance policy is:
- Contact the insurance help desk at the hospital.
- Show the ID card of the insured, provided by the health insurance provider, for the purpose of identification.
- The hospital will verify the identity of the insured and will submit the pre-authorization form to the health insurance provider of the insured.
- The insurance provider will review all the submitted documents and process the claim according to the terms and conditions of the health insurance policy.
- Some of the health insurance providers also assign a field doctor to make the hospitalization process easier for the insured.
- After the completion of all formalities, the claim is settled as per the terms and conditions of the policy.
PLANNED HOSPITALIZATION
Planned hospitalization comes in picture when the policyholder is aware of the hospitalization beforehand. The steps to claim cashless treatment in this case are:
1. Contact the toll-free helpline number of the health insurance policy provider beforehand.
2. Fax the pre-authorization form, which must be duly filled by the hospital, to the fax number of the health insurance provider.
3. Contact the toll free help line number of the health insurance policy provider beforehand.
EMERGENCY HOSPITALIZATION
Generally, an emergency hospitalization is needed when the insured meets with an accident or is suffering from an illness that needs immediate hospitalization.
1. In such a situation, the family of the insured is asked to contact the health insurance provider on their toll-free number after admitting the patient to the hospital.
2. Now, the pre-authorized form (fully-filled) has to be faxed on the numbers of the health insurance provider within 24 hours of hospitalization.
Claim Settlement Process for Health Insurance Reimbursement Claims
The general procedure to avail reimbursement claims for a health insurance policy is:
- Contact the insurance help desk at the hospital.
- Show the ID card of the insured, provided by the health insurance provider, for the purpose of identification.
- The hospital will verify the identity of the insured and will submit the pre-authorization form to the health insurance provider of the insured.
- The insurance provider will review all the submitted documents and process the claim according to the terms and conditions of the health insurance policy.
- Some of the health insurance providers also assign a field doctor to make the hospitalization process easier for the insured.
- After the completion of all formalities, the claim is settled as per the terms and conditions of the policy.
Insurance Salahkar – We provide fastest claim compair to others
For more details contact us on 9811985754 or email us on contact@insurancesalahkar.com
