Your health insurance policy is your shield against medical emergencies. Out of your pocket expenditure at the time of a medical situation can add to the stress. Knowing about your medical insurance and understanding the claims process can help reduce the outgo. Here is a step by step guide to claiming your medical insurance.
Know how it works:
Jargon like network hospitals, TPA and a pre-authorization form are not easy to understand. Knowing how your policy works can make the terminology friendly. The process of placing the claim may also seem easier. Your insurance company has tie ups with various hospitals, called network hospitals. You can visit any of them to seek medical help. Start with a list of the network hospitals closer home. The insurer's website has the list. A third party administrator (TPA) is in charge of approving and settling your claim. It represents your insurance company and settles all the bills with your hospital.
Know the coverage:
Your coverage is outlined in the policy you buy. The cover might depend on various factors like the premium you pay, your sum insured, type of policy etc. For example, your friend could be entitled to private room, while your entitlement is restricted to twin sharing. Treatment for some diseases might not come under your policy.
A rider can provide cover for the disease by paying an extra cost. Have a fair idea about your policy. A medical emergency might not give you the time to think, hence you could be better off taking a look at your policy beforehand. The policy may not cover some costs like admission/
Know your options:
You can make a claim on your medical insurance through the cashless or reimbursement benefit. Every health insurance policy comes with a cashless benefit. There are times when you know in advance about a health issue that needs medical intervention. At other times a mishap might lead to an emergency that might lead to hospitalization. Both planned and emergency hospitalization will need approval from the TPA for the claim settlement. A cashless settlement is likely to happen, when hospitalization is under network/listed hospitals.
During a medical emergency, if you are unable to reach a network hospital, you need to pay hospitalization costs. You can claim a reimbursement later. You must inform your insurance company with a certain time frame, usually 24 hours. You may need the admission form, discharge summary, bills and other documents when you fill out a claims reimbursement form.
Medical emergencies are not the best time to read and understand the insurance guidelines. Knowing your insurance coverage will help you make a successful claim on your policy.
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