What is the process for making health insurance claims during medical emergencies?

We all buy health insurance policies for the simple reason that they would cover the costs of our treatment in some way or the other. This is why before you purchase any such policy, it is essential to look at the claim settlement ratio of health insurance companies so that you can make the best choice in this regard. The good thing is that in most cases, the insurers have relatively simple claims processes. If you have the correct documents with your claims, you can be sure that they will get processed without any hiccup at all. It is essential to know how to do such work not to be caught unawares during an emergency.

Making a cashless health insurance claim

You may have chosen an insurer with the best health insurance claim settlement ratio, but your job surely does not end there. First, you need to know how to go about these things. You would already be aware that you have 2 kinds of health insurance claims – reimbursement and cashless. In the case of cashless claims, you have to follow a few steps. First of all, you would have to inform the hospital. After this, you would have to inform the insurer. Along with all these, you also have to know the hospitals that are a part of your insurer’s network so that your cashless health insurance claim could be a successful one.  

Making a reimbursement health insurance claim 

In this case, you would have to get admitted to a hospital – it would not matter if it is a part of your insurer’s network or not. In case there is a medical emergency, you have to get admitted so that you can get the necessary treatment. 

After that, you would have to pay the bill so that you can get discharged from the medical facility. Then, you would have to send the bill along with the necessary documents – including the health insurance claim form – to the insurer. It would reimburse your expenses in due time. Please remember that in this case, the insurer would be adjusting the deductible.

Process for making health insurance claims during medical emergencies in India

If your health insurance covers a critical illness, you can claim for it by following this particular process during Medical Emergencies in India

• Inform the hospital 
• Getting the third-party administrator card 
• Inform the insurer 
• Knowing the network hospitals  
• Document required to file an insurance claim

Inform the hospital 

In the first stage, inform the billing desk of the hospital of the cashless health insurance policy that you have. Have you planned your hospitalization? In that case, it would be better to inform them before you even get admitted. However, this is not how the cookie crumbles in case of emergencies. So, have someone with you who knows about such a policy – it could be your friend, relative, or anyone else close to you.

If you are with a family member covered by the same plan, the responsibility of providing such information will fall on you.  

Getting the third-party administrator card 

This card is also known as the TPA card. You would get it from your insurer when you buy a policy with an emergency claim facility. So, when you or someone else covered under such a plan is getting admitted to a network hospital, show this card at the TPA counter of the hospital or billing desk. 

It is always better to have this card with you. This is an important part of knowing how to make health insurance claims successfully. This way, in case of a medical emergency, you – or someone assisting you with hospital admission – would be able to show the card and get the job done.  

Inform the insurer 

Your insurer needs to receive immediate notification regarding your hospitalization. It needs to happen as early as possible. Once they get such intimation, they will work with the TPA and the hospital. They would make sure that the entire cashless claim is settled properly. 

Knowing the network hospitals  

When it comes to making a medical emergency insurance claim, this is an important part of the process as well. So, it is always advisable to have proper knowledge in this regard. You can be sure that if a hospital is not part of said network, your cashless claim would not be settled over there by the insurer. So, in case you are facing a medical emergency and looking to get hospitalized, it is better to go to a network hospital.   

Document required to file an insurance claim

Following documents are an integral part of the health insurance claim process and, as such, you need to furnish them as part of your claim application: 

• a claim settlement form that has been filled properly 
• original pharmacy bills
• medical certificates that have been attested by consulting doctors 
• original hospital bills
• summary of discharge 
• copy of FIR (first information report) if applicable
• copies of prescriptions  
• legal documents would be needed in case of accidents 

It is better to keep these documents handy with you when you file a claim. This will make sure that the process gets over smoothly and in a short time. That way, it would also be a lot easier for you to get your health insurance claim in case of medical emergencies.  

Conclusion:

If you wish to be successful with your claim, you have to be honest with the insurer. Be careful with them in these cases. You must never lie on the claim form. Also, when you buy the policy, inform the insurer about any illness that you have already. Disclose your complete previous health record to them. If you have to, go for a critical illness policy so that you can stay protected in the best way possible.

Remember to submit the right documents so that you do not face any issues at the time of processing your claims. Knowing how to claim health insurance is better to avail a hassle-free claim settlement process when needed.