How Long Does a Health Insurance Claim Take?

Health insurance prevents your hard-earned money from going towards hospital bills in case of an uninformed medical emergency. You can claim for expenses incurred towards different things with a health insurance plan and that leads us to one of the most important questions— ‘How long does a health insurance claim take to complete?’ Any individual who is looking to choose a health insurance plan wants to know about the time it will take to get his or her claim.

The first thing you should understand is that health insurance companies provide two methods to file a claim – Cashless and Reimbursement method. So, the time within which an insurer settles the claim will depend on the claim method you are choosing. In the case of a cashless claim method, individuals don’t need to pay anything from their own pocket as all the medical bills are directly settled by the insurer or the Third Party Administrator (TPA). However, in the reimbursement method, you need to pay the bills from your pocket, and the insurer will later reimburse the expenses incurred during treatment.

In this article, we will be discussing all such things that you should do to get your claim faster by both cashless and reimbursement methods along with the steps required to file your claim. Keep reading to know more!

Things To Keep in Mind When Going for a Cashless Claim

With the cashless method under any health insurance plan, you don’t have to pay any money towards your treatment in the network hospitals specified by your insurer. So to get a faster claim, you should go to the nearest network hospital. If you don’t have any idea about the network hospitals, you can go to the official website of your insurer where you can see the list.

If you are getting hospitalized for planned surgery, you should approach the chosen network hospital before the date of admission. This will help the hospital fill the pre-authorization form and send it to the insurer. If you are admitted into a hospital on an emergency basis, you will need to intimate your respective insurer within 24 hours of hospitalization via call or email. In the case of the cashless claim method, the insurer will assess all the documents submitted by the network hospital. After the verification, the insurer will directly settle the bill with the network hospital.

We are showing the steps that you need to follow if you want to make a cashless claim. Have a look!

1. Intimate your insurer about the hospitalization in the network hospital before or within 24 hours of the hospitalization.
2. Submit all the relevant papers to the hospital such as the pre-admission investigation paper and doctor’s consultation paper. The network hospitals will verify the documents to authenticate your identity.
3. After getting discharged, the hospital will directly settle the bill with the respective insurance company.

Things To Keep in Mind When Going for a Reimbursement Method

In the reimbursement method, you will need to first pay all the bills from your own pocket and the insurer will reimburse the amount later. Individuals get the reimbursement amount in their bank accounts usually within 15 to 30 days after filing the claim. However, this duration changes from one insurer to another and depends on several factors such as the claim settlement ratio of the insurer, medical bill amount, the validity of the information, etc.

When going for a reimbursement method, you should claim for the expenses incurred towards your treatment within 15 days from the date of discharge. Do remember if you want a faster claim, you should intimate about your claim within 24 hours of hospitalization at either network or non-network hospitals.

To file a reimbursement claim, you will need to follow a few simple steps shown below. Please check!

1. After admission into the hospital, get the required treatment and pay the bill. After getting discharged from the hospital, collect all the original documents.
2. You will need to submit the necessary claim documents within 15 days from the date of discharge.
3. Provide the policy number to receive the claim form. After filling the form, submit it along with the claim documents.
4. The insurer will assess all the details submitted by you and will reimburse it within 15 to 30 days if everything goes right.

One of the important things to get the claim quickly is to know the necessary documents for the reimbursement method. We are showing them below. Please check!

1. Copy of Health ID Card
2. Properly filled claim form
3. Pre-admission investigations and doctor’s consultation papers
4. Original discharge summary from the hospital
5. Investigation reports such as X-rays, scans, blood reports, etc.
6. Cash receipts from hospitals & chemists
7. Medico-Legal Certificate (MLC) and/or FIR in case of an accident
8. Copy of KYC documents
9. NEFT details, contact number and Email ID
10. Pharmacy invoices authorized by respective prescriptions