Sometimes there are also cases where due to a miscommunication, even after a medical insurance procedure is completed with the health insurance plan, the procedure for making the claim for health insurance is not easily understood by the consumer. Both these situations arise due to lack of communication about medical insurance between the insured and the health insurance companies.
Since claims do not arise as soon as medical insurance is done, there is a general tendency to put away the policy papers without an in-depth study or clarification of doubts. Health insurance companies understand medical emergencies and put out detailed procedures for making claims and also give information about what is covered in the medical insurance and what is not.
Health insurance claim are entertained by the insurance companies without to and fro if the procedure is correctly followed. Clearing a claim would take time as there are a lot of things to be verified. A Health insurance claim needs to be checked by the health insurance companies for their accuracy and admissibility and along with completion of associated documents. Many insurance companies, issue a health card to the insured. This health card like an ID establishes the identity of the insured.
These are important for making claims related to medical insurance. You need to know the list of hospitals approved by the insurance company with whom they conduct business of health insurance. Reputed insurance companies have a large chain of network hospitals across the country,posted in the websites.
If you want to avail of the cashless hospitalization facility: Check the network hospital list to see if your hospital is included in the chain. Make a note of your policy number. The number is available on your health card or on the policy document. For up-to date information on coverage, verify from the company’s claims cell. Take a copy of the pre-authorisation form and your health card to the network hospital.
The pre-authorization form is to be filled up by the hospital and endorsed by the doctor. The hospital on completion of the form will send a fax to the insurance company or TPA as the case may be. If you do not want to avail of the cashless facility, you have to settle your bills at the hospital and submit the important documents to the insurance company. Some of the documents that can be submitted are: Claimant statement form duly filled and signed Copy of health card Certificate of attending doctor Discharge card or summary Hospital/doctors/medicine bill.
When you apply for a health insurance claim, be sure that you have all these above mentioned documents in order. Summary: After the medical insurance is done, health insurance claims may arise. Often, there is delay in settling claims and health insurance companies are blamed. However, if the procedure for making a claim after medical insurance is explained and mentioned, there would be less cause for complain. For documents to be submitted for health insurance claims, contact the website of the health insurance companies.