How to Submit a Health Insurance Claim for Reimbursement?

Medical insurance plans are a necessity in today’s times. With rising costs of medical treatments and increased incidences of lifestyle-related illnesses, medical bills can corrode your savings in no time. With the right health insurance, you can be assured of being financially protected during any medical emergency.

Many insurers even offer critical illness insurance wherein the policyholder is paid the sum assured if diagnosed with the covered critical illness. Most insurers allow people to buy online health insurance to save costs and time.

If you don’t have a health insurance policy yet, it’s time to start considering it and protect yourself from medical emergencies in the future.

Insurance providers offer two types of medical insurance coverage:

  1. Medical claim reimbursement policies: where the policyholder settles the hospital bill and then applies for reimbursement.
  2. Cashless health insurance policies: where the policyholder provides the insurance policy details to the hospital, and the hospital gets the bill settled directly by the insurance company.

In this article, we will talk about medical policies where you must file a claim for medical reimbursement and look at the things you need to know to file a claim.

When will you have to file a medical insurance reimbursement claim?

There are three scenarios under which you might have to file a health insurance reimbursement claim:

  1. You have purchased a health insurance policy that does not offer cashless hospitalisation
  2. You want to undergo medical treatment at a hospital that does not feature in the list of network hospitals of the insurer
  3. The insurance provider has rejected your cashless hospitalisation request

How to submit a health insurance reimbursement claim?

Here are the steps to help you file a health insurance reimbursement claim:

1. Inform your insurer

Many people think they need to inform the insurer about hospitalisation only in the case of a cashless claim. However, this is needed for a reimbursement claim too. Ensure you inform the insurance company of the hospitalisation at least 48 hours before the admission. If you are being admitted due to an emergency, ensure that the insurer is informed of the same within 24 hours of admission.

2. Start the treatment and pay the bills

Once you have informed the insurer, you can start the treatment and pay the bills as needed. Also, the entire bill should be cleared before you get discharged.

3. Maintain a file with all the required documents

Before you get discharged, make sure that you collect all the reports, bills and the discharge summary. These documents will be required by the insurer to honour your claim. If any documents are missing or the hospital tells you that you can collect them later, then make sure that you keep track of such documents and get them collected.

4. Submit your claim request to the insurer

After being discharged, approach the insurance provider and ask for a claim form. Fill out the form with the requested details and attach the relevant documents. Most insurers require policyholders to submit a medical reimbursement claim within 15-30 days of discharge.

5. Claim evaluation and payment

Once you have submitted all the documents requested by the insurance provider, your claim will be evaluated and cross-checked with the coverage available under the policy. Within 30 days, the insurer will inform you about the status of the claim. If more documents are required, then the insurer will inform you accordingly.

Documents needed to file a medical insurance reimbursement claim

While the list of documents will vary for each case, here is a standard list to help you get started:

  • Health insurance claim form that is duly filled and signed
  • A copy of the health insurance policy
  • Investigation reports like sonography, CT scan, blood test, etc.
  • The consultation papers and prescriptions of the doctor
  • Discharge summary from the hospital
  • Hospital and medicine bills
  • Receipts of all the bills paid at the hospital
  • KYC documents

Summing Up

Remember, every insurance provider can have a different process for accepting a medical reimbursement claim. Hence, make sure you know the process before buying a policy. Also, opt for cashless insurance wherever available, as it can save you the hassle of paying out of your pocket and applying for reimbursement later. Good Luck!