How to be prepared to have hassle free treatment & claims process in personal health insurance

An insured purchases a personal health insurance policy after a thorough understanding and comparison. But the job does not end there.

A health insurance policy is a good deal only if you get your claim settled hassle-free. But the insurance company alone is not responsible for getting this done for you. There are a couple of steps that you should follow, not after the occurrence of an emergency but when you have purchased the insurance policy.

There are 2 ways claims are settled in health insurance:

1) Cashless,
2) Reimbursement

Cashless treatment:

In this type of claim, the insurer will have a tie-up with certain hospitals where the insured can go for treatment on a cashless basis. Such hospitals are listed as ‘Network Hospitals’ in the policy bond. In Cities, all good hospitals will have a tie-up with insurance companies.

• What are the Benefits of Super Top Up Health Insurance Plan?

How to be prepared for Cashless treatment:

3- Keep a note of the point of contact:

Make a note of 3 contact details in a row as below in your phone contact list once you purchase the policy.

I) Broker/Agent Health Insurance
II) Cust. Care Health Insurance Co.
III) Relationship manager Health Insurance Co.

The customer care people would help you with the nearby network hospital list. However, it’s better to make a note of the nearest network hospitals in your daily routes and keep your family informed accordingly right after the purchase of health insurance. This would save a lot of time in case of an emergency.

Carry your health card:

Be it a group policy or retail, insurers issue a health card in the name of the insured. This card will have details of the insured and proof of insurance. The insured should always carry this card in his/her pocket. This will be useful in case there is an emergency and you are not with any of your known people. If the hospital gets proof of insurance, they will start the treatment without waiting for any known person of the insured.

Always Carry your ID proof:

It’s a good practice to carry your ID proof with you in your wallet all the time, not only for insurance but for many other needs in day-to-day life.

Reimbursement Case:

If the treatment is not happening in a network hospital, then the insured has to first pay from his pocket then the insurer will reimburse the expenses upon submission of all the bills.

There are certain drawbacks to this type of claim settlement:

• All of a sudden, you may have to dig cash out of your pocket.
• There will be a delay in treatment until you submit the deposit amount.
• The insurers will find higher chances to avoid whatever expenses they could on some of the other grounds.

Hence, we should follow the below steps along with the steps mentioned for cashless to avoid any issues in the claim:

How to be Prepared for Reimbursement Claim:

If for some reason you are not able to avail of the cashless facility, then along with the steps mentioned above for cashless settlement, you should be prepared with the following steps for a claim on a reimbursement basis.

Deadline to intimate about the claim:

Read the claim settlement process in the policy document carefully so that, you should not miss anything from your side on which the insurer may find reasons to disregard the claim or deduct any payable amounts.

For example, it is a standard policy of all insurers to intimate them about the claim, within 24 hours of hospitalization. Make a note of such points and share them with your family too. In the case of planned treatment, the insured has to inform the insurer at least 4 days before treatment.

In cashless treatment, this will be taken care of by the hospital.

Make a file of all medical bills and reports:

• The insured should always make a file of all the medical expenses and reports in a sequence.
• This you need to submit to TPA or Insurer’s Inhouse settlement team for verification and calculation of the payable amount.

Keep a copy of the documents with you:

Remember, you would need to submit the original documents for reimbursement. Never forget to keep a copy with you before submitting it.

Conclusion:-

This way you can avoid any hassles in claims when you are already dealing with some emergency. Firstly, we should follow all our steps rightly as mentioned above. If still your claim is rejected, the law favors the insured more than the insurer. You will have an option to approach the ombudsman, who has its own jurisdiction to file a complaint against Insurer.