Health Insurance Claim Reimbursement filing process

 

When any person gets hospitalized and they are required to file health insurance claims there are so many confusions regarding the process of filing the health insurance claims. In this article we will discuss how to successfully submit a health insurance reimbursement claim.

Insurance plans let regular people afford even the most expensive medical care. Depending on your financial situation, you can get a health insurance policy and pay a monthly payment in exchange for access to cashless medical care or a reimbursement claim when you need it.

When a health insurance policyholder faces a claim scenario due to an unexpected medical event, the first thing they should do is verify whether or not the hospital where they will get care has a cashless facility. In the absence of a cashless facility, the policyholder will be responsible for paying the hospital's fees out of pocket before submitting a reimbursement claim.

Find out in this study what the procedure for filing a claim for reimbursement entails:-

While in or out of the hospital

Planned hospital stays for things like surgery or medical treatment require informing your third-party administrator (TPA) or insurance company ahead of time about a potential health insurance claim. A notification to the third-party administrator (TPA) or insurer must be made quickly in the event of an emergency. Your claim is less likely to be denied if you notify the appropriate parties in a timely manner.

Admission Procedures and Related Paperwork

Do check for the eligible bed/room charges according to your policy document. Try to get the bed/room which has minimal charges as all charges related to treatment are co-related with the cost of bed. More will be the cost of bed/ room charges more will be the cost of all related treatment charges, even surgery charges get increased with the type of bed/room you select for treatment.

Every hospitalization-related form must be obtained in the standard way. Depending on the situation, you may additionally need a Hospital Registration Certificate. The insured party must submit a claim form. After leaving the hospital, you have 15 days (or whatever the deadline is) to file your claim. The claim form must be accompanied by all supporting documentation. The policyholder must also provide bank statement cancellation as evidence of financial stability. This is where you might expect to find the money from the insurance company after filing a claim.

Acceptance and action

The insurer will check the given papers and reports before approving a claim once they have been sent to the TPA/Insurance Company office in the specified manner. More evidence could be required to support the assertion. After reviewing the claim thoroughly, the insurer may decide to accept all or part of it, and they will let the policyholder know their decision.

Consumables are not covered by most of the insurers so they will not be reimbursed by your insurer. Do check with the hospital what consumables they are charging for and request them to reduce the consumables to minimal levels.

 

Aspects to keep in mind

• Familiarity with the policy's claim clause is recommended in order to submit a complete and well-documented request for reimbursement.

When filing a claim, be sure to include any relevant medical documentation and bills in their original form. The policyholder is advised to preserve a duplicate of any paperwork submitted to the insurance company.