Some formulations have to be completed to take an insurance claim. During this time, some necessary documents have to be copied. Claims are finalized on this basis.
By the way, health insurance has always been important. With this, the expenses of the entire medical treatment including the hospital can be reduced. In the era of Corona epidemic, health insurance has become even more important. If you or someone in your family has taken insurance and unfortunately the policy holder dies, then a death claim can be taken on it. Apart from this, an insurance claim can also be taken for treatment. To apply for a claim it is important to keep some things in mind, so let us know what are those things.
There are two types of insurance claims
There are usually two types of health insurance claims. The first cashless claim and the second reimbursement claim. In cashless claim, if the insured has opted for this option, then the customer will get the benefit of cashless facility in the implanted hospital. Under this, you can treat the patient in selected hospitals where there is a tie-up of the insurance company. According to the terms of the insurance policy, the percentage of treatment expenses that will be paid will be provided by the insurance company.
To avail the cashless facility, the health ID card has to be shown at the insurance / TPA desk. After this, the process will start between the hospital and the insurance company. Now, treatment of corona has also been included in the category of cashless treatment under the new rule of IRDA.
Under the reimbursement claim, if the client chooses a hospital that is not registered with the insurer, then the client can claim the claim from the insurer by paying the expenses incurred during the treatment. Such claims are usually settled within 5 days.
Cashless claim process
To apply for a cashless claim, customers have to contact the insurance desk of the hospital. Here the insurer gives the application form (which is signed by the treating doctor), it has to be filled. It will be sent to the insurance company, after the approval, the insurance company will pay the expenses incurred in treatment. Approval should be taken 4 to 7 days before treatment.
During this time, the insurance holder will have to submit a photocopy of the pre-authorization letter (filled by the insurance desk), ID card, Aadhaar card, PAN card etc. issued by the insurance company or health insurance policy. When the treatment is done and the customer has availed the cashless facility, the original bill and proof of treatment will have to be submitted to the hospital. If an insured has to be hospitalized in an emergency, the policyholder can contact the insurer through the facilities of its customer service center or chatbot. This will help in getting admitted in registered hospitals.
Documents required for reimbursement claim
In order to take a reimbursement claim, the insured has to download the required claim documents from the insurance company website or from the insurer’s office. The customer is required to submit the necessary documents along with the original medical bill at the time of filing the claim. These documents include claim forms, bank statements, ID cards, hospital discharge summary, check and digosis reports and bills, original hospital and pharmacy bills as well as payment receipts and prescriptions. In addition, in case of accident, hospitalization, a copy of the FIR may also need to be shared with the insurer.
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