Articles 734 views January 9, 2020

Tips to Ensure You Get the Health Insurance Claim

Health insurance is one of the most useful and critical forms of insurance. You need to have a health insurance plan to ensure you get the desired medical attention when there is a requirement. This helps you to stay fit and get back to health after an illness, accident, etc. Health insurance claims are paid out in two ways, namely, cashless and reimbursement. You can choose the type of payout you wish when selecting and buying the health insurance policy. Read on to know more about the types of health insurance claims, their features, benefits and so on.

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Understanding health insurance claim

A health insurance plan is a contract between the policyholder and the insurance company. The insurance company promises to compensate the policyholder for all his medical expenses. In return, the policyholder promises to pay the health insurance premium. The compensation paid out to the policyholder is the health insurance claim. Here, the claim can and paid in two ways, cashless or reimbursement.

Cashless health insurance claim

As the name suggests, a cashless claim allows you to get treated in a hospital without having to make any payment. The hospital directly pays the hospital on your behalf and you get to walk out after your discharge.

1. Advantages – A classless health plan allows you to get treated in a very smooth and hassle-free manner. You don’t have to worry about running around, arranging documents, etc. You just need to inform the insurer about your upcoming hospital stay in advance, if it is a planned one. In the case of an emergency, you need to inform the insurer within 24 hours of getting admitted. Once that is done, the insurance starts to coordinate with the hospital and pays the amount of your bill directly.

2. Points to remember – It is very important to note that the cashless claim can only take place in a network hospital. A network hospital is a hospital that has a tie-up with the insurance company. Every health insurance provider gives you a list of network hospitals. If you do not go to any of these hospitals, you cannot make use of the cashless health insurance claim facility.

Reimbursement health insurance claim

At times, the insurer requests you to settle the bill amount at the hospital by paying the bill out of your own pocket. Then, after you are discharged and you get back home, you need to inform the insurer about the payment and have them reimburse the amount. This is known as a reimbursement health insurance claim. Many documents are required for this. These include the hospital bills, the doctor’s certificates, pharmacy bills, etc. You need to submit these documents, along with claim application form and get the amount reimbursed. It is a simple process but needs to be done in a proper, quick and error-free manner.

1. Advantages – The biggest advantage is that you get to choose your hospital when you go for a reimbursement facility. In a cashless option, you are forced to get treated at a network hospital. The hospital you are comfortable with may not be on the list. But when you do not go for the cashless option, you can go to any hospital or nursing home in the city and easily get treated.

2. Points to remember – The reimbursement needs to be done on time. You thus need to be prompt with the claim application. Also, do not make any voluntary or involuntary mistakes in regards to the amount, the documents, etc. Then your health insurance claim will be processed quite smoothly.

Tips to ensure you get the health insurance claim

Here are some tips to ensure you always get your claim and it is never rejected:

1. Pay the premium on time – It is of utmost importance that you pay the premium on time. Unless the health insurance premium is paid, the policy won’t remain active. Even if the policy lapses for one day and you need to make a claim on that day, you will not get the cover. You never know when your health may fail, so keep the premium payments cleared and be prepared to make a successful health insurance claim at any time.

2. Be truthful – You need to be completely honest in regards to health insurance. This includes being honest when buying the plan and when making a claim. Do not lie about your lifestyle habits, pre-existing illnesses, etc when you take the policy. If you do so, your claim will be rejected later on. Then, if you lie when making a claim, your claim will be rejected as well. So be honest and easily get the health insurance claims processed.

3. Understand the exclusions – Every health insurance plan has a list of exclusions. You need to be aware of these exclusions and ensure you do not make a claim on those. For instance, if your health plan has an exclusion for diabetes, you cannot make a claim for any diabetes-related ailments.

4. Honour the waiting period – Make the claim after the mentioned waiting period is over and it will surely get processed. If you try to make a claim while the waiting period is in force, the claim will obviously be rejected.

5. Apply in a proper manner – As mentioned above, a health insurance claim may be a cashless claim or a reimbursement claim. If it is a cashless claim, you need to inform the hospital and your insurer right at the time of getting admitted, or at the earliest possible time. For a reimbursement claim, you need to be quick and not waste any time after your discharge. File the claim promptly. If you file the claim properly and on time, it will get accepted, else it may get rejected due to lapse of time.

Keep the above-mentioned information in mind when understanding the health insurance claims. You will be able to know what type of plan you have and make a successful claim consequently. A health insurance plan is a great resource that you must have to stay fit, healthy and secured.