7 tips on how to make health insurance claims successfully

Updated: Jul 03, 2019 1:46 PM

Health insurance is not mandatory but it is gaining a lot of popularity thanks to rising medical costs.

Health insurance, health insurance claim, Insurance companies, health insurance policy, reimbursement claimsIn case your hospital is not a part of your insurance company’s cashless hospital network, you will have to opt for reimbursement claims.

Pollution, sedentary lifestyle, and lack of nutritious meals has made the urban population vulnerable to diseases. From visiting a doctor for a routine check-up to undergoing a surgery, medical expenses have skyrocketed. In such a scenario, the thought of spending a week in a hospital is enough to send shivers down the spine of a common man. However, there is a ray of hope in the form of a health insurance policy.

Health insurance is not mandatory but it is gaining a lot of popularity thanks to rising medical costs. It offers financial support in case of medical conditions. Insurance companies charge a premium to insure you against medical conditions. You can raise a health insurance claim and the insurance company will honor your claim after conducting their basic inspection. Read ahead to know more about raising a successful health insurance claim.

Types of Claims

  1. Cashless Claims

Insurance companies have tie-ups with a number of hospitals to manage claims. Collectively, they are known as network hospitals. If you are admitted in a hospital which is a part of the network hospital, the hospital and the insurance company settle your hospital bill amongst themselves. You might have to pay a nominal amount. Apart from that, your claim is cashless i.e. you do not have to pay the bill amount. Comparatively, this is quicker and convenient than reimbursement claims.

2. Reimbursement Claims

In case your hospital is not a part of your insurance company’s cashless hospital network, you will have to opt for reimbursement claims. You will have to pay the hospital bill on your own and then get the amount reimbursed from your insurance company. Comparatively, this is a time-consuming process.

Raising A Claim

3. Transparency

You have to maintain complete transparency while purchasing a health insurance policy. You have to declare any existing medical conditions upfront. Fill the insurance application as well as insurance claim form accurately. Any information if found to be fabricated can mean you are engaging in insurance fraud and your claim shall not be approved.

4. Coverages

Every health insurance policy has certain coverages and exclusions. Different policies offer different coverages. Your claim shall be honored only if the medical issue is mentioned under coverages in your policy. The terms and conditions mentioned in the policy have to be met for a smooth claim settlement process.

5. Which One to Claim?

Those working in a corporate office might be covered under group health insurance. This insurance cover is offered by the employer for their employees. In some cases, it also extends to the employee’s family members. This is usually a basic health insurance plan. People often choose an individual health insurance plan and use the office insurance policy as extra cushioning. While raising a claim it is beneficial to raise a claim first from the group policy and then consider your individual policy. This way, you will be in a better position to keep your individual health insurance policy’s No Claim Bonus active.

6. Documentation

Whether you are filling an online insurance claim or an offline claim, you need to provide supporting documents along with the claim. These documents include medical bills (for reimbursement claims), your bank details for transfer of amount, etc.

7. Seek Help

You can initiate the health insurance claim by: sending an email to your insurance company, calling them to register the claim, visiting their website, or calling their executives. If you need any kind of assistance, you can get in touch with your insurance company on call or through social media and seek help regarding raising a claim.

Online Health Insurance

Nowadays, you can simply log on to your insurance company’s website and purchase online health insurance. You can also raise a claim easily through the website. Make sure to renew your health insurance policy in a timely manner to keep your health insurance policy active.

(Biresh Giri,  Appointed Actuary, Head of Product Development & CRO,  Acko General Insurance)

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