Steps to File Health Insurance Claim

If you’re lucky then filing claim for your medical insurance plan will be a smooth process. Otherwise, filing claim can be an annoying process for some people. If there isn’t any support from your insurance provider then, it could be problematic for you. There can be situations where cashless facility won’t be provided by the nursing home/ hospital. The incurred hospitalization expenses can be claimed after the patient is either discharged from the hospital or his/her treatment is completed. People buy Mediclaim policies so that they don’t have to face any financial at the time of hospitalization.

If you have to register a medical insurance claim, you should keep all the receipts and set them in a chronological order. You need to get a claim form from your medical insurance provider. After that, you have to prepare Xerox copies of the original form for claim submission, review it and then dispatch all the documents. Before you do that, you are advised to read the fine print of the policy document very carefully. You must keep all the bills, receipts along with the medical reports that you have got at the time of the hospitalization and 30 days before and 60 days after hospitalization. The health facilities availed during this time period which is a part of the treatment, are applicable for the reimbursement.

Here are the details that will help you to understand the claim filing process in a better way.

You can file a claim under a medical insurance plan in the following two ways.

  1. Cashless basis
  2. Reimbursement basis

Cashless Basis- For a cashless basis claim, your need to undergo the treatment specifically at a network hospital that is providing its services to your insurance provider. You’ve to seek authorization for undergoing the medical treatment on a cashless basis according to the laid down procedures in the form. Read the policy documents the moment you get it so that you get familiarized with the process so that filing for a claim becomes a smooth process for you.

Reimbursement Basis- Carefully read the clauses regarding the claims in your insurance document after you get it to make sure that you get the understanding of the procedure as well as the required documents for filing a claim for reimbursement. When you need to file a claim, inform your insurance provider. After hospitalization, make sure that you get all the documents. Once you get all the documents, keep the documents like claim form, prescriptions, discharge summary, bills etc. with care as you need to submit them for filing a claim.

Generally, all the medical insurance claims need to be registered within seven days of discharge or completion of the treatment from any of the network hospital. Keep in mind that health insurance providers won’t pass the claims if any of the documents aren’t in coordination with their terms and conditions.

We hope that now you know what is the process of filing an insurance claim and what are the steps involved in this step.


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