After undergoing hospitalization and paying huge bills, if you are worrying as to how you would file your insurance claim with the Health Insurance Company, follow these simple rules and be sure to get your bills paid.
If you have bought a health insurance policy which covers the disease for which hospitalization took place you would be reimbursed for the medical expenses incurred before, during and after the hospitalization.
Another way by which you can claim is known as 'Cashless Hospitalization' wherein you are hospitalized in a network hospital and the charges for the whole hospitalization are directly paid by the Insurance Company through the TPA or Third Party Administrators.
It is more beneficial to avail the Cashless Hospitalization but in case you haven’t, Don’t fret, simply follow these rules:
- In case, you have to follow the claim settlement process on your own, then you need to first find out who is the TPA on the policy. This would be mentioned clearly on the policy schedule provided to you.
- Read the policy conditions to make sure that the illness/condition is covered.
- Remember to keep all the bills connected to both, pre as well as post hospitalization, including prescriptions and receipts of consulting fees paid to doctors, invoices and receipts provided by the hospitals and the pathology lab, the consultation reports and receipts, carefully in a file.
- Find out who is taking care of your claims. Call up your Insurance Broker/Agent. A good Broker/Agent would help you end-to-end on claims.
- Remember receipt is a very important document to be submitted. An invoice is only a liability, the receipt actually documents the payment made.
- Fill out the Claim Form provided by the Insurance Company or available with your HR Department if you are insured under the Group policy.
- The list of essential documents is mentioned below. Try to scan or photocopy each of these documents and send the original to the TPA (your TPA name, number and address are provided on you Health Card and the Policy). Make sure that you provide each one of these to the TPA.
Claims form: Filled and duly signed by the insured. Sometimes, this may require signatures from the doctor who is treating you.
Discharge card: The follow up document given to you when you are discharged from the hospital, contains details like date of admission and discharge, treatments and follow up checks you need to undergo.
Letter of 1st consultation, advice for hospitalization: This letter must preferably be on the letter head of the doctor along with his signature recommending hospitalization.
Proper Hospital Bills: Bills with pre numbered receipts, stamped and containing the registration number of the Hospital are required.
Medicine Bills and Doctor’s Prescription: Medicine bills and prescriptions with the patient’s name mentioned therein are essential.
Investigation Reports, Bill Receipts and Advice letter for all the tests performed: All the reports have to be signed by the Doctor.
Consultation receipts: Proof of payments done to Doctors.
Remember to send all these documents to the TPA within 7 days of hospitalization.
- Be patient as the process for insurance claims settlement can take a minimum of 21 days, and the number of days can increase if you don’t provide all the required information the first time.
- You can check the status of your insurance claim settlement process with your Agent, your Broker or directly with your TPA.
You should not be fazed if your insurance claim is denied. If the reason provided by the TPA seems unsatisfactory, you could contact the Ombudsman (an impartial intermediary) and state the problem, you are likely to be satisfied by the Ombudsman.
Remember, being clear about the Policy wordings, following the claim process diligently, and having a clear communication will settle your claim in no time.
