How to Claim Health Insurance?

Usha, a middle-aged widow, worked in an event management company. One day while organizing a party for children, she suffered a sharp pain in her stomach. She visited her trusted doctor immediately. The doctor diagnosed her illness as appendicitis and advised her to undergo surgery promptly, which she did.

A few years ago, before her son left for the U.S.A., she had bought a medical insurance policy at his insistence. She was thankful to have taken the decision, as it would take care of her treatment expenses now. She heaved a sigh of relief when the doctor informed her that the surgery was successful. However, with little knowledge of insurance, she was stumped and was wondering how to go about claiming health insurance.

Health insurance claims or mediclaims, as popularly known, are generally classified into:
A. Reimbursement claims, and
B. Cashless claims
Here are a few easy tips that will help you understand how to avail the benefits of your health insurance plan easily.

A. Reimbursement Claims

Under these claims, the insured pays the medical and surgical expenses to the hospital. He then makes a claim to the insurance company to reimburse that money to him. The insurance company gives him the money in accordance with terms and conditions stated in the policy document. Broadly, the steps for claiming a reimbursement are:

Collect: You need to collect all the documents from the hospital and carefully store them. A few of the required documents are:

1. Discharge summary, medical bills with doctor's prescriptions

2. Hospital bills and all medical reports like blood report, etc.

3. Payment receipts and doctors consultation papers

4. First Information Report (FIR), in case of accidents

Send: Download the claim form from your insurance company's website. It needs to be duly filled and signed by you and your treating doctor (remember to ask for the doctor's stamp and ensure he mentions his contact details while signing). Send the form along with the original documents within the prescribed time limit to your insurance company.

Await: After receiving the form, the company reviews your claim. Await their feedback. They may ask you for documents that you might not have submitted or raise a query. Track the status of your claim online. Remember not submitting all relevant documents may delay the process or lead to claim rejection.

Receive: You receive intimation from your insurer about your claim. If approved, the amount is promptly paid to you.

B. Cashless Claims

Cashless claims offer the advantage of getting treated without paying any money to the hospital. The amount is directly paid by the insurance company to the hospital. This saves you the hassle of arranging money and helps you concentrate on your treatment.

Cashless claims maybe for planned as well as for emergency hospitalization. Here's the procedure for planned hospitalization:

In case of emergency cashless claims, the process is similar. However, you may intimate your insurer after getting admitted and receiving medical aid. Though this is the general process to claim health insurance, there might be slight variations from company to company. It is advisable to read the fine print in the policy document and keep customer care contact details handy for a fast, easy and smooth process.