How to request reimbursement from health insurance?

How to request reimbursement from health insurance?

New Delhi: With Covid-19 still a health threat across the world, people are looking for health insurance to protect themselves and their families. An informed health insurance policy can help individuals reap the maximum benefits of the policy. One should be informed of the needs and requirements, as well as the reimbursement process based on medical history and family requirements.

The health insurance claims process involves either a cashless transaction which is a direct claims settlement option or reimbursement of medical claims. In the latter case, the policyholder pays the hospital bills out of pocket and then claims reimbursement from the insurer. The reimbursement facility can be used in network and off-network hospitals.

However, unlike cashless settlement, the refund process is long and relatively slow. When filing refund claims, there are certain bottlenecks that claimants find it difficult to navigate.

The first step is to inform the insurance provider, the third party administrator (TPA) of the hospitalization or treatment as soon as possible. The insurer can also be informed after hospitalization in the event of an emergency.

Here’s how you can file a claim and receive the claim amount from the insurer.

First, you need to notify your insurer / third party administrator (TPA) about the processing within the allotted time. If there is an emergency, the indication can be given to the insurer / TPA after admission.

Required documents

The documents required to submit a claim for reimbursement are the health card issued by TPA, the original copy of the hospital discharge summary, the completed claim form, investigation reports (such as x-rays, blood, etc.), pharmacy / pharmacist prescriptions bills, copy of KYC documents and bank details for NEFT purposes.

All documents should be carefully checked before submitting them to the insurer. The policyholder must keep copies of all documents sent to the insurer for reimbursement. This will help you with your communication or disputes, if any, in the future. Document review is necessary prior to submission, as your claim may be rejected if insufficient or incorrect documents are submitted to the insurer.

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