Health Insurance 660 views April 17, 2021

Health insurance is essential to secure yourself and your family financially against medical expenses. The insurance company provides you appropriate medical health coverage for the treatment of your illness or injury. But what documents do you need for health insurance claims? If you are new to health insurance and don’t know about claim documentation, read this post further as we have mentioned the same here.

Health Insurance

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Types of Health Insurance Claims with their Supporting Documentation

Insurance companies provide you two types of claim payment modes – both of them require specific documentation. Know more about these claim procedures below –

Cashless Claims

The cashless claim is possible when you receive treatment at a network hospital of the insurance company. Here, the insurer settles the bill directly with the network hospital as per the terms and conditions laid down in your health insurance plan. You can check your insurance company’s network hospital list on its official website. However, you need to ensure the necessary paperwork for a cashless claim at the network hospital. Check out the steps for a quick claim processing-

  1. Contact your health insurance company by calling the toll-free number or sending an email to their official website
  2. Show your health card or policy number at the network hospital
  3. Fill in the pre-authorization form and send it to your insurer
  4. When the claim is approved from the insurer end, you can seek medical treatment without any hassle
  5. After your discharge, the hospital will send the discharge summary, diagnostic reports, main hospital bill to the insurer for the settlement of your medical expenses

Note – In case of emergency hospitalization, your attendee can perform the above-mentioned claim process.

Reimbursement Claims

If your cashless claim is rejected or you get admitted to a non-network hospital, you need to pay the medical bills to the hospital directly and get it reimbursed from your insurer after getting discharged from the hospital. For this, you need the following documents –

  1. Duly filled claim form
  2. Medical Certificate of the attending medical practitioner/doctor
  3. Discharge summary or card (original)
  4. Medicine prescription and cash invoice from pharmacies/hospital
  5. Investigation report
  6. FIR or Medico Legal Certificate (MLC), in case of an accident-related hospitalization
  7. Payment receipts
  8. Doctor’s report related to your illness or injury treatment
  9. Canceled cheque or duly filled ECS form so that the insurer can transfer money to your bank account.

Things to Keep in Mind While Filing Health Insurance Claims

Read on the following notes and know the things to keep in mind while claiming health insurance:

  1. Submitting the correct documents is crucial for claim approval.
  2. Health insurance provides reimbursement for pre-and post-hospitalization expenses as well. Just submit the required documents to the insurer within the stipulated time, otherwise, you cannot file a claim for such medical expenses.
  3. If you provide any fraudulent documents for the treatment of illness/injury, your claim request shall be rejected immediately. And such fraud is also a crime under federal law, so you might face legal trouble as well.
  4. You will get a claim amount up to your policy coverage limit. So, if the hospitalization expenses exceed the same, you need to bear the extra sum
  5. Many health insurance policies have an initial waiting period from the date of policy inception. During this period, you can’t file a claim for any illness treatment/surgery, except for injuries that have occurred due to an accident

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