Claiming Your Medical Insurance? Here’s What You Need To Know

Medical and Health Insurance Claim Form

Choosing the right health insurance is absolutely imperative because no matter how strong your immunity system is, there’s no telling when or where an unforeseen health condition might strike you. Such is the unpredictability of life that you always need to have a backup plan to deal with any unsavory situation that might arise, in this case, health related concerns.

Having a medical insurance saves you the trouble of scurrying around to mobilize funds for treatments at the last moment, reducing stress buildup in the process. But it isn’t the end of the road as you also need to know the specific details relevant to your policy and how to make a claim when the situation demands it.

If you belong to the group that doesn’t exactly know the ins and outs of applying for a medical insurance claim, you are in the right place.

What Can You Claim For?

Money Control makes it clear that with a medical insurance, you can not only request reimbursement for the hospitalization charges, but also for the pre and the post hospitalization expenditures related to the ailing condition you were admitted for.

Almost all insurance policies in the market allow you to claim the costs sustained during, before, and after the periods of hospitalization as long as they are incurred on the health condition you were admitted for. But technically you can only claim expenses that are listed in your policy, so you should be extremely diligent in reading the insurance related documents before applying.

The Claim Process

Before you learn about the claim procedure, you need to understand that all the insurance companies provide you with two different options.

1.     Cashless Facility

Most of the insurance firms have teamed up with some of the best hospitals to offer their patients with what is known as the ‘Cashless Facility’. This means that your medicals bills are paid for by the insurance companies to the hospitals without you having to worry about it. But there’s a catch. To avail of this facility, you need to get the treatment from only ‘Network Hospitals’ i.e., hospitals affiliated with insurance companies.

This facility requires you to first inform the insurance company of the medical issue so that they can get your file started. You will then have to officially request the hospital to fill in a cashless request form and submit it to the relevant insurance provider. Once your provider receives the application from the hospital, they will reply with a confirmation on the request along with the details of the treatment costs the policy covers. The account is settled after the discharging process, only if the treatment received is listed in the policy cover.

2.     Reimbursement Of Fees

Under this option, you are again expected to inform the insurance provider about the hospitalization a little before or 24 hours after admittance (in case of emergencies). You will have to pay for the entire treatment by yourself while keeping all the relevant bills to be later submitted to the provider. Once the documents provided are vetted by the ‘Claims Management Personnel’ you will get a refund of your expenses.

When Can You Claim?

Any health insurance can be claimed only when the insurer or the individuals listed in the policy has been admitted in the hospital for a period of about 24 hours. The exception to this rule is the ‘Day Care Treatments’ under which you can claim the insured amount even if the period of admittance is less than 24 hours. This usually includes short but significant surgical procedures like Cataract surgeries, Chemotherapy, and others among a list of 150 surgeries which are listed on the ICICI Lombard’s Medical Policy Annexure. This number may vary depending on various medical policies.

What Are The Things One Must Keep In Mind Before Filing A Claim?

There are a lot of customary things you need to follow to the Ts, so that you have a hassle-free experience when you file a claim. Here are a few of them as suggested by Economic Times.

The Do’s:

  • If you are going for planned hospitalization, make sure to inform the insurance company before getting admitted. This period should be a maximum of 24 hours in case of emergencies.
  • Make sure to collect all the related files and documents pertaining to your treatment procedure if you haven’t received treatment in a network hospital. This will make the process easier.
  • Provide the right information in the settlement form. Mention pre-existing health insurance, if any, as failing to declare any pertinent information asked for by the company may result in your claim being rejected.

The Don’ts:

Never falsify any information, since this might lead to the cancellation of your existing policy.

Don’t make any repeated claims on a condition which doesn’t warrant any reimbursement. This could lead to an increase in premium and eventual rejection of your pleas.

Always be diligent enough to submit the required documents within the stipulated time as delay might turn the company against you.

To sum it up, there a huge number of health insurance providers who offer policies with varying terms and conditions. So be well informed before applying for the right policy as it will have a huge impact on your or your family’s future.

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