Tips on Settling Your Health Insurance Claim Faster

Uncertainties related to health are a part of life. And although you cannot prepare yourself for health uncertainties, you can certainly be financially prepared against the health risks using health insurance.

While buying health insurance is easy, claiming health insurance can get very complicated. Most policyholders do not know how to fill medical claim form and because of the incomplete information, they end up with a rejected claim. However, with the right advice and careful actions, you can get your claim settled and receive the maximum pay-out without much hassle.

So, here are 5 very important tips to help you make the health insurance claim process quick and hassle-free.

1. Send Timely Claim Intimation

In case of a reimbursement claim, intimation is the first step that must not be missed. It requires the policyholder to inform the insurer about the hospitalization of the patient, and hence, the forthcoming claim. An intimation can be sent via email, call or the website of your insurer and you must send an intimation.

• • 3-4 days prior to the admission of the patient in case of pre-planned hospitalization
  • Within 24 hours of admission of the patient in case of emergency hospitalization

If the insured fails to send a claim intimation, the insurance company will raise a query. However, with a valid justification, you can resolve the query.

2. Get Pre-Authorization

Pre-authorization is the process of establishing trust between the insured and the insurer. The hospital checks the eligibility of the claim before initiating a cashless claim by sending the pre-authorization form filled by the policyholder to the insurance company. To get a pre-authorization, the insured needs to present their original identity proof and the insurance policy card to the hospital.

However, the most critical step is to correctly fill the preauthorization form based on which your eligibility for a cashless claim is checked. Here are a few important things to keep in mind:

• • Do not use abbreviations while filling the form; the information in the fields must be clearly deciphered.

• • Seek claim assistance from a claim expert if the hospitalization is pre-planned.

• • Attach the documents required in the correct order as per the policy.
  • Justify your claim in preauthorization form by including:
    • • The reason for hospitalization or the diagnosis history
    • • The plan of treatment
    • • Number of days the patient will be hospitalized for
    • • Approximate cost estimation of the treatment
    • • Credentials of the doctor

3. Resolve Queries on Time

In case of reimbursement claim, if the insurance company finds any discrepancy in the documents or the medical case of the insured, it raises a query that needs to be acted upon by the insured. And, most of the claim settlement processes fail because the insured does not resolve the query raised by the insurance company in a timely manner.

The insurer sends 3 reminders to the policyholder. And if despite 3 consecutive reminders, they do not resolve the query, their claim is rejected. So, in addition to responding to the query quickly, here’s what you must do:

• • Track the claim settlement process by getting in touch with the insurance company or TPA (if associated) though call or website. This will help you resolve the query in case you somehow miss the reminder.
  • Represent your case clearly by presenting all the required documents in response to the query.

4. Establish Trust

Patients often make mistakes while filing a claim which cost them a great deal. And the reason behind this is carelessness. They assume that the absence of a single document must not impact the process if the insurance policy, anyway, has to cover the treatment cost. And this feeling of entitlement, in most cases, lead to claim rejection.

The health insurance claim process, however systematic, is influenced by the trust between the insured and the insurer. Which is why disclosing all the details during the claim settlement process is as important as disclosing pre-existing ailments while buying the policy. So, as a proof of honesty, you must submit all the original documents mentioned in the insurance policy and arrange them in the right order to reduce the risk of human error at the insurer’s end. The documents include:

• • Copy of Gov. Id Proof with Insurance card

• • Original Hospital Discharge Summary

• • Original Itemized Bills

• • Hospital Bill & Breakup

• • Original Investigation Reports

• • Original Pharmacy Bills

• • Original Prescriptions

• • Copy of FIR/Medico-Legal Certificate (only in case of accidental injury)
  • Original Cancelled Cheque

5. Contact a Claim Expert

The insurance policy certificate is a complex document which consists of terminologies that are almost impossible for a layman to understand. This is why policyholders end up making decisions with incomplete or incorrect information they have. Moreover, misunderstandings while filling a claim form and attaching the documents to submit a reimbursement claim request may lead to rejection of the claim or deduction in the claim amount. Hence, to avoid making a costly mistake, you can contact a claim expert who will –

• • Answer all the doubts you may have.

• • Prepare your claim form so that you don’t need to struggle.

• • Help you with online self-claim preparation.

• • Guide you step-by-step through the claim process.

• • Identify the right documents. Resolve the query raised by a TPA and help you submit a grievance.

These tips will not only make the claim process easier for you but will also help you ensure that you get the claim pay-out that you deserve.

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