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Health Insurance Claims Settlement Process

 

What is Health Insurance Claims Settlement Process

 

Knowledge of your insurance policy and claims process will make your life easier

 
 

A health insurance claim can be delayed or rejected for a range of reasons, from administrative delays by hospitals to poor documentation, further inquiries by the insurer or even poor understanding of the policy by the policyholder. But you can prevent the claims process from turning sour by arming yourself with proper knowledge of your health insurance policy and the process involved in making the claim. Further, you will need to proactively engage with the hospital and the insurer to avoid delays.

 

Before buying a mediclaim policy:

  • Make sure the policy covers hospitalisation
  • Go through the policy's list of exclusions and waiting period
 

Exclusions are typically medical conditions and procedures that are excluded from the policy's coverage. Waiting periods may be applied after a policy is purchased overall as well as for specific diseases and pre-existing conditions.

 

  • Note the co-payment and sub-limit clauses
A co-payment clause means that you pay a percentage of the claim amount. A sub-limit means that the insurer's liability for specific ailments, or expenses such as room rent, is capped.
 
 
  • It is better if your neighborhood hospitals are in the insurer's network
  • Make sure the policy is cashless since it means faster settlement of claims
 

While making a claim

  • While getting admitted in the hospital know the insurance approval amount
  • Keep the insurer informed as and when hospital costs exceed the approved amount
  • Make sure the paperwork is in order a day before the discharge
  • Ask the hospital's insurance helpdesk to prepare the relevant documents so that they can be sent to the insurer immediately before the discharge is ordered







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