Ways to make a claim
One must proceed according to insurer's norm while making a health insurance claim; else one is likely to encounter delays in the processing of the claim.
Documentation must be correctly prepared:
One must provide original and authentic documents for:
1. Final bill. Break up of various bill heads need not be specified.
2. Authentic and whole discharge care document which must mention the entry and exit time of the treatment.
3. Original investigation reports attached along with the prescription and requests.
4. One must also present pharmacy bill attached along with signed claim forms.
Claims must be made in time:
One must submit the documents within 30 days after the patient is discharged so that compensations can be duly made. In order to avoid delays, one must their claims on timely basis.
Procedure for cashless settlement:
When one buys a cashless health plan from a policy maker, one must be issued an ID card mentioning the name of a third party administrator (TPA). TPA aids you in processing of a claim and helps in rightful billing at the medical organization where one has got treated or has been examined for a critical illness or disease.
There may be two cases when it comes to hospitalization. Namely:
Planned Hospitalization
One needs to contact the Third Party Administrator in order to inform them for the planned hospitalization. It is essential to check for the coverage terms of one's policy and make certain that the hospital or medical facility where you plan to get treated is in the Insurance companies set of connections.
In cases, where the medical facility or the hospital is not in the insurance company's area of network, then it is difficult for the cost to get covered. And, if your insurance company provides you with cash-less ability then it is a must to inquire from the TPA in order to follow the due process.
Unplanned Hospitalization
It is important to update the TPA quickly in order to obtain the claim forms and to understand the measure while filing for a claim. Bear in mind that all your claims and related documents must be filed within 7 days of treatment.
One needs to get all the essential documentation, once the treatment is complete. This can be obtained from the hospital and the surgeon. One needs to settle all the bills from his or her own pocket in order to get the compensation from the insurance company. One needs to tally with their policy in order to cover both- pre hospitalization and post hospitalization expenses.
In some cases, your claim might not be passed if at all the treatment of the critical illness or disease is not supported by your health insurance policy. However, if your claim is rejected, make sure you are writing to your insurance company within a time span of 15 days, in order to lodge a complaint.
One needs to check with their TPA, in cases of partial payments. However, mostly in all the cases offering additional documents will help in recovering the left over claim.
