Health Insurance Claim Settlements-Know The Process Here

Health insurance claim settlements should be an effortless process for the insured. To ensure this, it is important for all to know the conditions process to avail the settlements.

So, let us understand the process of claim settlement first. 

Immediately as the insurer is informed by a policyholder’s attendant about the occurrence of an ‘insured’ event, the insurer verifies the validity of that health insurance. The network hospital will notify the insurer to initiate the verification process. Then an assigned field doctor will consider the request for the document of pre-authorisation to cross-check the treatment that the claim is made for.

Once the verification has been done, the medical team from the insurance company will approve the cashless claim for the person insured on the basis of the policy terms and conditions.    

Also read: All You Need to Know About Cashless Claim Policy

Conditions For Health Insurance Claim Settlements

Some important conditions you need to know to avail of health insurance claim are-

• If the details filled are incomplete, the process of authorisation can be canceled. 
• All the claims have to be filed within 30 days from the date of discharge.
• The insured individual will pay for non-payable items from own.  
• If a policyholder has to claim the complete expenses incurred during post-hospitalisation, he/she is required to submit all the required documents within 30 days from the date of discharge.   

Points to Remember in Such Times for a Speedy Health Insurance Claim Settlement

Major points to remember at the time of cashless claims or reimbursement policies are-

• The form for reimbursement claim must be completed and submitted with the original supporting documents.
• The documents should include doctor’s prescription recommending for hospitalisation. It has to be given to the insurer to show that the doctor had recommended the hospitalisation.  
• All the original hospital bills are required to be deposited.   
• Discharge Card that the hospital had issued is also needed. It must state that the insured is stated fine for the discharge. 
• A copy of the bills and all the forms must be retained by the policyholder for future use. 
• A follow up a prescription is also needed. It must show the policyholder is fit after hospitalisation. 
• The insurers settle the bill in around 15-21 working days after you have submitted all the necessary documents.

Also Read

When Can Health Insurance Claims Be Rejected?

Best Health Insurance Companies in Claim Settlement

Take Away

In short, the main points to ensure speedy and smooth settlement of life insurance claims are listed below-

• Fill your proposal form carefully 
• Submit correct documents
• Provide disclosures

So, there may also be delay/denial in the health insurance claim because, for say, the claimant fails to submit the necessary documents or follow the required procedure. So, to avoid dissatisfaction, it is important for the policyholder to take proper steps and ensure an effortless claim settlement.  

Apart from cashless claims, there are several other benefits of having a health insurance policy. To buy one and make the most of it, you can get in touch with the experts at Insurancedekho.com. You may also write to us at customersupport@insurancedekho.com to seek help in buying the best deal according to your needs.