There are two ways to make claim under a Health Insurance Policy: on cashless basis and on a reimbursement basis. In simple terms, for making a claim on cashless basis, the treatment must be done only at a network hospital of the insurance company servicing your policy. For availing the treatment, you would have to first seek an authorization as per the procedures laid down and in the prescribed form. In case of claims on reimbursement basis, the insurance company has to be informed as per their prescribed procedures. The policyholder has to ensure that documents such as claim form, discharge summary, prescriptions and bills to be submitted for reimbursement claim are obtained after hospitalization.
Cashless Service: Seeking Pre-Authorization
Complete the pre-authorization form available at the hospital's insurance/TPA Desk. Send the completed form via email or fax. Approved letter will be sent by the claim management team. Remember that the claim management team could send an inquiry to the hospital or you before authorization. In case the authorization is rejected, initiate the treatment and file claim for reimbursement.
Reimbursement Claim: Claim Submission
Complete the necessary form and submit along with required documents, as per the policy terms and conditions. Necessary documents include discharge summary, prescriptions, bills etc. Approved letter will be sent by the claim management team. Remember that you will be answerable to any queries raised by the claim management team before the letter is issued. In case the claim is rejected, the reasons will be communicated by the team. In case of any emergencies, you need to inform the insurance company within 24 hours of the admission. In case of planned emergencies, the notification has to reach the company 48 hours prior to the hospitalization.
