Health Insurance Claim

Insurance Claim for Health

A request for services that are covered by a health insurance policy is known as a health insurance claim, and it is made to the insurance company by the policyholder. For the used medical services, a health insurance policyholder has two options: they can either get paid or choose direct claim settlement (commonly known as cashless treatment). This enables one to either submit the claim form or ask for cashless services from the health insurance company.

 

Health Insurance Claim Types

The real value of a health insurance plan is its ability to provide medical care when it is required. One must start the health insurance claim process in order to guarantee the prompt and simple payment of all medical bills. Claiming a health insurance policy can be done in one of two ways:

CASHLESS CLAIMS: In a cashless claim, the insurer pays the hospital directly for all associated hospital expenses. To receive the advantages of cashless hospitalization, an insured person must only be admitted to a network hospital.

REIMBURSEMENT CLAIMS: In this kind of claim procedure, the policyholder pays the hospitalization costs in full and afterwards asks the insurance company for reimbursement. In this situation, both member and non-network hospitals offer the option of payment.

 

The Health Insurance Authorization Process

The insurer confirms the legitimacy of the policy and the policy coverage of the policyholder as soon as the insurer receives the notification from the attendant of the customer and is contacted by the clinic (network) about the same. The demand for the pre-authorization document is then facilitated by a field physician, who is also tasked with verifying the alleged treatment. Following verification, the insurance company’s medical team accepts the policyholder’s cashless claim in accordance with the terms and conditions of this contract.

 

Important Requirements to File a Claim for Health Insurance

  • If the details are incomplete, the authorization process may be cancelled.
  • After the discharge date, all claims must be submitted within 30 days.
  • The insured is responsible for covering the full cost of all non-payable items.
  • Within 30 days of the discharge date, one must submit all necessary documentation in order to submit the full post-hospitalization expenditure claim.

 

Important Requirements to File a Claim for Health Insurance

  • If the details are incomplete, the authorization process may be cancelled.
  • After the discharge date, all claims must be submitted within 30 days.
  • The insured is responsible for covering the full cost of all non-payable items.
  • Within 30 days of the discharge date, one must submit all necessary documentation in order to submit the full post-hospitalization expenditure claim.

 

Process for Resolving Health Insurance Claims Compensation Claims

The following steps should be followed to submit reimbursement claims for a health insurance policy:

  • Make contact with the hospital’s insurance help desk.
  • For identification purposes, present the ID card issued by the health insurance provider to the insured.
  • The hospital will confirm the insured’s identity before submitting the pre-authorization form to the insured’s health insurance company.
  • All of the provided documentation will be examined by the insurance company, and the claim will be handled in accordance with the terms and conditions of the health insurance policy.
  • Some health insurance companies will additionally send a field physician to assist the insured throughout their hospitalization.
  • The claim is resolved as soon as all formalities have been completed.