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Health Insurance Claims Process Explained

Updated: May 10, 2019



Health insurance policies are all about obtaining financial coverage and medical aid. It is a prudent way of preparing for the unforeseen medical events. A Mediclaim backup gives you the financial assurance and the absence of it can lead to a financial crunch. However, if the health insurance claim process is tiresome then the insured members cannot benefit. The process of getting reimbursement for the medical services that has been charged is what constitutes the health insurance claim process. A few guidelines can explain how to claim health insurance money when the need arises.


There are two types of claim settlement:

  1. Cashless

  2. Reimbursement


STEPS FOR CASHLESS CLAIMS


• People can definitely opt for cashless hospitalization when treated for an ailment. Given the ailment is covered in the Terms and Conditions of the health insurance plan. Also, the concerned hospital should be a part of the insurer’s network of healthcare providers.


• At the time of admission, individual need to contact the TPA desk of the network hospital to get the Pre-authorization form filled. Apprise your insurance company beforehand as the TPA sends over the form for their final approval.


• The Third-Party Administration counter will take into submission any pertinent documents. This may include the cashless health card, provided by your insurer. Also, for verification purposes, copies of certain KYC documents will be retained.


• By this time, the insurance company gives their cashless approval for your hospitalization. They keep an account of all the documents concerning your treatment and during your stay. It is advisable that individuals also obtain a copy of the same for record-keeping.


• The claims will be settled smoothly if you follow the above-mentioned guidelines. Ensure that all medical reports, physiological tests, discharge bills, etc are intact with you. All these documentations must be kept for future requirement or reference.


STEPS FOR REIMBURSEMENT CLAIMS


• Reimbursement claims can be demanded out-of-network hospitals as well. Inform your insurance company about your impending claim. Fill up and submit the reimbursement claim form to them. This must be done within a month from the discharge date from the hospital.


• Along with the claim form, submit the duly signed and sealed bills related to the hospital. Double check for certain mandatory elements in the hospital bill. These include the registration number of hospitals, patient name, admission date and the doctor’s prognosis prescription. The final document ensures that the hospitalization was not a self-made decision but a doctor’s recommendation.


• Collect the Discharge Card that is given by the hospital on the day of release. This should be submitted to the insurance company.


• One can also claim pre and post hospitalizations charges in reimbursement type of settlement. One has to submit the pertinent bills to the insurance company. It can be done within 60-120 days, according to the statements in their health policy.


• In both types of claim settlement, all the medical and hospitalization data must be stored safely.


Individuals should not be intimidated with the financial jargons in the insurance policy. By scrutinising every line, one can easily claim and settle their dues with the insurer. Learn how to claim health insurance money by showing interest and a little bit of effort.

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ManipalCigna Health Insurance Company Ltd (Formerly known as CignaTTK Health Insurance Company Limited) | CIN U66000MH2012PLC227948 | IRDAI Reg. No. 151 
Reg. Office: 401/402, 4th Floor, Raheja Titanium, off. Western Express Highway, Goregaon (East), Mumbai- 400 063 | Toll free number – 1800-102-4462 | Website address – www.manipalcigna.com
Trade Name / Trade Logo belongs to MEMG International India Private Limited and Cigna Intellectual Property Inc. and is being used by ManipalCigna Health Insurance Company Limited under license. For more details on risk factors, terms and conditions, please read the sales brochure/ sales document available on our website (Download section) before concluding a sale.

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