Steps for Filing a Medical Claim Reimbursement

Buying a health insurance policy is vital to ensure the financial security of the individual at times of medical emergencies. There are two types of health insurance options available, namely cashless hospitalization and insurance on a reimbursement basis. In case of reimbursement, the insured person will get treatment from a non-network hospital and pay the medical bills from the pocket. These bills will be paid back by the insurance company, upon approval.

Steps to File A Health Insurance Reimbursement Claim

For reimbursement of medical expenses, the bills and all pertinent reports should be sent to the health insurance company within 30 days of discharge. Insurers should read the terms and conditions of the policy closely and follow the desired steps to claim reimbursement. The steps to follow while filing the reimbursement are as follows,

1. Prepare Hospital Bills in Order of Occurrence

This is the first step in the health insurance reimbursement process. Get all receipts of medical bills, x-ray reports, lab reports, consultation fee invoices, and discharge summaries in original and arrange them date-wise. Also, arrange the pre and post-hospitalization bills for consultation, lab tests, and pharmacy bills for reimbursement. Make sure that the bills that are submitted contain the date of the bill, the tax invoice number, the name of the client, the consulting doctor, and the bill amount with GST, along with the signature of the concerned person.

2. Download the Reimbursement Form

Visit the website of the insurance company and download the claim form from the website. Print the form and fill the part A of the form. Part B of the form will be filled by the hospital personnel. Give required details such as policy number, name, and address, hospitalization details, a checklist of the claim documents, details about the bills submitted, and the bank account details. In part B of the form, the hospital will fill in details about the diagnosis and treatment.

3. Prepare the Documents

To file for health insurance reimbursement, attach all the bills and receipts and take a copy of all the documents, to be sent to the insurance company through the post. Also, attach an identity proof with a valid ID and a canceled check with the documents. The policyholder should preserve a copy of all the documents as proof in case any of the documents should get missed during transit.

4. Recheck Before Submission

It is better to review and recheck all the documents before mailing them to the insurance company. After submitting all the required documents for reimbursement, inform the health insurance company regarding the submission. Instead of mailing by post, the documents can be submitted directly to the insurance company as well.

Bottom Line

The health insurance company will evaluate the case and the documents that were submitted and if it approves the bills, the cost of the bills will be reimbursed to the bank account of the insured. The payback period can span from seven to fourteen days. If the documents are found to be incomplete, or if the claims are rejected, then the claimant will be informed by the insurance company with reasons.

Disclaimer: This article is issued in the general public interest and is meant for general information. Readers are advised not to rely on the article's contents as conclusive and should research further or consult an expert in this regard.