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Insurance Article

The Dos and Don'ts of Following Health Insurance Procedures

September 17 2015

The Dos

1. Use the insurance company's online hospital locator to identify the general and specialty hospitals closest to you.

2. Keep your health insurance ID card handy in the unfortunate event of an emergency.

3. Know that procedures for cashless network hospitals and reimbursement claim network hospitals are different.

4. In case of cashless facility in an emergency, ask the hospital to fill up the Cashless Request Form and submit it to the insurance help desk at the hospital. For a planned treatment, it is advisable to follow the above procedure 3-4 days in advance so that you can walk in for treatment with a confirmation letter. The insurance company or the Third Party Administrator (TPA) will authorize the coverage and settle the bill directly with the hospital.

5. Be aware that reimbursement claims happen in two cases: when the treatment is done at a hospital outside the preferred network and when the treatment is done at a network hospital but is not covered in the policy.

6. Always keep liquid money ready in case the claim falls in the reimbursement category, in which case all bills will need to be paid first.

7. Carry all necessary original documents from the hospital to be submitted to the insurance company for reimbursement claims. Always keep a photocopy as a backup.

8. Treatment bills obtained 30 days prior and 60 days after hospitalization are generally applicable for reimbursement, so keep them safely.

9. A co-payment means the claim amount will be divided between you and your insurance company by a certain percentage. It is wise to check for this option beforehand.

The Don'ts

1. If possible, avoid unprepared visits. Call the insurer first to discuss your cover including any waiting periods, exclusions, minimum benefits, excess and copayments.

2. Do not opt for rooms or facilities that have upper limits and various sub-limits to avoid out-of-pocket expenses.

3. Do not assume that the health insurance cover is for lifetime or does not have a maximum renewable age.

4. Educate yourself about limits on specific treatments insurers may have.

Whether it's a planned visit to a hospital or an unfortunate one, it is imperative that we familiarize ourselves with the procedures of claim insurance so we can focus all our attention on our loved ones. Thankfully, health insurance exists to ease the stress of financial burdens during such trying times. Stay safe and healthy!

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