Health Insurance 1428 views April 16, 2021

People choose health insurance to protect their finances when faced with a medical emergency. When you choose a health insurance plan, it helps you get claims up to the chosen sum insured when dealing with a medical emergency. Talking about health insurance claims, it can be settled via two methods – Cashless Claims and Reimbursement Claims. With the cashless claim method, the insurer directly settles the bills with the network hospital. But how do you get your medical expenses reimbursed from the insurer with the reimbursement claim method?

This post can help you know the answer to this question as we will discuss the steps to get your medical expenses reimbursed from your health insurance. While knowing this, you can also understand some crucial things about the reimbursement claim method. So, let’s start understanding the steps.

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Steps to Get Your Medical Expenses Reimbursed from Health Insurance

With the reimbursement claim method, you need to pay bills by yourself upfront to get the treatment. The insurer will reimburse your medical expenses later. You can choose the reimbursement method in the following two situations.

  1. If your cashless claim gets rejected at a network hospital (tied-up hospitals with respective insurer) due to some reason, or
  2. You are getting your treatment at a non-network hospital (due to some emergency or unavailability of network hospitals nearby)

In both situations, you will need to follow the steps mentioned below to get your medical expenses reimbursed from your health insurance company. Please check!

Step 1: Get hospitalized in the desired hospital.

Step 2: Get the required treatment at the hospital and pay the medical expenses upfront as per requirement.

Step 3: After getting discharged, you will need to submit the following documents to your insurer via its online portal or email or send them to its head office address.

  1. Properly filled claim form align with policy number
  2. Health card or Policy copy.
  3. KYC documents (Photo ID, Address and age proof)
  4. Original discharge card/ Daycare summary/ Transfer summary or death Summary
  5. Original final hospital bill (with break up along with all the original deposit and final payment receipts)
  6. Original invoice with the payment receipt for those charges billed outside the main hospital bill
  7. Invoice for all implants used during the surgeries
  8. Letter from the treating medical practitioner stating complaints, duration, history and treatment details
  9. Previous consultation papers for the current disease
  10. All the original diagnostic reports (including imaging and laboratory) along with prescriptions and bills
  11. Pharmacy/Medical Bills along with prescription
  12. NEFT Details

For Accident-related Cases, you will need to submit the following extra documents.

  1. Medico Legal Certificate MLC/ Copy of FIR
  2. Letter of the treating from a medical practitioner stating the details of accident/trauma and influence of alcohol/intoxication
  3. Pre and post-operative imaging reports

Step 4: Once your insurer receives the required documents, it will scrutinize them thoroughly before approving your reimbursement claim. On successful approval, the insurer will transfer the reimbursement amount to your registered bank account within a fixed time (varies from one insurer to another).

Note: To get your medical expenses reimbursed successfully from the insurer, you should submit the documents within 7 to 15 days after getting discharged from the hospital.

Important Things Related to the Reimbursement Claim Process

You should remember the following things when getting medical expenses reimbursed from an insurer. Have a look!

  1. You should collect all the bills (related to treatment) carefully to get your medical expenses back successfully from the insurer. On missing any of the expenses-related documents, the insurer may reject your claim.
  2. You can get the treatment at any hospital and get the expenses reimbursed later by submitting all the required documents.
  3. You need to follow a due procedure in the case of a reimbursement claim process. So, the process may take time. Also, you may have to bear the financial burden upfront when you choose this process.

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