Health Insurance 2791 views January 9, 2020

Tips to Ensure You Get the Health Insurance Claim

A health insurance plan is a contract between the policyholder and the insurance company, which promises to compensate the former for their medical expenses should they face a health emergency. 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 be paid in two ways, cashless or reimbursement. Read on to know more about the types of health insurance claims, their features, benefits and so on.

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Cashless Health Insurance Claims

As the name suggests, a cashless claim allows you to get treated in a hospital without having to pay for it. The hospital pays directly to the hospital on your behalf.

1. Advantages – A cashless 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 company coordinates with the hospital and pays the bill directly.

2. Points to remember – It is very important to note that the cashless claim can only take place in a network hospital, which is a healthcare unit with which the insurance company has a tie-up. Every health insurance provider gives you a list of network hospitals where you can have cashless treatment.

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 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. While this is generally the case for treatment at other than network hospitals, sometimes cashless claims may not be possible even at network hospitals. Many documents are required for this claim. These include the hospital bills, the doctor’s certificates, pharmacy bills, etc. You need to submit these documents along with the claim application form and get the amount reimbursed.

1. Advantages – Compared to the cashless option which is restricted to just network hospitals, reimbursement is available across all the hospitals. So, the hospital you are comfortable with may not be on the list of network hospitals. In that case, the reimbursement option will come to use.

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 with regards to the amount, the documents, etc. Ensuring the same will mean a quick processing of your health insurance claim.

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 important for you to 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 with 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 taking the policy. If you do so, your claim will be rejected later on. Also, if you lie when making a claim, your claim will be rejected as well. So be honest and get your health insurance claims processed smoothly.

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 claim for those. For instance, if your health plan has an exclusion for diabetes, you cannot 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 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 admission, 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.

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