Health insurance claims may often seem to be a tedious process. Lengthy paperwork, numerous medical bills, and yet it may at times remain unsettled. To reduce discrepancies, avoid rejection and make your health insurance claims hassle free, here are some quick tips.
1) Explore your policy at the time of purchase
A very basic thing to be done for a hassle free claim is to know and understand your health insurance policy. And this is to be done, not at the time of a claim, but right at the time of your policy purchase. Different health insurance policies have different features and benefits. It is important to understand the policy you are buying; what exactly you are entitled for, the medical conditions and procedures you would be covered for, and what the policy excludes. A clear understating of the policy tells you how to make a claim and what could be done when a medical emergency strikes.
2) What is your insurer’s track record?
When purchasing insurance it pays to check on your insurer s track record. Check on his settlement ratio. Higher the ratio, the better his efficiency in settling claims, handling the process and in customer servicing. Such an insurance company makes your job easir, without much of harrasement when handling a claim.Do a compartitve study of the various insurers before taking a plunge.
3) Disclosures to be complete
From the time you fill up your health insurance proposal form, till submission of claims, it is vital to make accurate and complete disclosures. There should be no ambiguity when it comes to disclosing details regarding age, medical history, present health condition, family medical history and habits. Wrongful/incomplete disclosures would give rise to delay or even rejection of your claims.
4) Use network hospitals- Makes your job simpler
All insurance companies have a list of panelled hospitals across India. It saves you time and energy, to use these network hospitals. Remember cashless benefits are offered only in network hospitals.
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5) The cashless benefit
Cashless facility in health insurance plans are truly a convenient facility. It pays to opt for these benefits as they reduce a lot of paperwork. In cashless benefits you get cashless treatment at the network hospitals of your insurer. All that is needed to be done is to complete a request form and submit at the hospital, along with the necessary medical records. Once the TPA approval is through, you get your medical treatment, without having to make immediate payments. This facility saves the trouble of filing for claims, up to a certain limit.
6) Know the deadlines and time frame
One of the important reasons for delay in settlement of claims is non adherence to the stipulated time frame during which claims are to be submitted, along with the necessary documents, to the insurer. Post hospitalisation, it is important to submit all documents in an orderly manner on time. In general the following documents would have to be submitted for a health insurance claim
• Complete claim form attested by the doctor treating you
• A summary of the discharge report
• Bills and receipts in proof of payments made to hospital
• Laboratory and diagnostic reports such as X-ray, scans, etc...
A Final Word…
Insurance is based on the principle of utmost good faith. It is a faith that insurance companies have on the insured that his disclosures are complete and true. Just as important it is on the part of insurance companies to make the entire process simpler and provide all the necessary support to the insured, it is the duty of every insured, to be honest in his declarations. Many a rejections could well be avoided if one abides by policy guidelines and regulations.
For a hassle free health insurance claim, know your rights, follow the regulations and take certain precautions. This would definitely not give insurance companies a reason to reject your claim.
The author is the CEO of MyInsuranceClub.com, an online insurance price & features comparison portal
For more articles by Deepak Yohannan, please visit MyInsuranceClub.com
You may contact him directly on Twitter: @dyohannan