health insurance

In this fast-paced life, a comprehensive health insurance policy is a must, whether from a financial point of view or for your peace of mind. No one can predict the future, and knowing that one has a financial safety net is vital in more ways than we can think. A good comprehensive health insurance policy can make a huge difference to your well-being in times of sudden medical emergencies.

Having a good health insurance policy is only half the job complete since one has also to know how to claim the health insurance amount successfully. It can be a bit confusing with a lot of moving parts, especially in stressful situations. This article will highlight a few tips for filling health insurance claims to make those confusing times a little stress-free. 

Health insurance claim process

As mentioned above, the buying process of a Niva Bupa Health Insurance policy is often seamless, but the claim process can be fairly complicate if we are not well-inform about the process. In this context, we have to understand that the health insurance claim process can be of two different types:

Cashless Process 

This kind of claim process, as the name suggests, is done without needing cash between the hospital and the insurance company.

Reimbursement Process 

This claim process is mainly done post-hospitalization with the insurance company reimbursing the claimant after they send them the medical bills for the treatment.

Cashless Claim Process for Health Insurance

When an insurance company authorises a cashless claim process, it generally means that the insurance company has a tie-up with the hospital, and the hospital staff will automatically send them the report of the treatment expenses. The insurance company will verify the report and directly pay the hospital for the medical costs incurred by the policyholder. Remember that this process can be possible only in the insurance provider’s network hospital that supports a cashless claim process.

Planned Hospitalisation

Planned Hospitalisation is a process in which a person has a predetermined date for a medical procedure or hospitalisation. In such cases, the claimant has to follow these steps for a successful health insurance claim process:

  • The claimant has to inform the insurance company at least three to five days before the medical procedure. It can be complete via letter or email.
  • During this period, the hospital and the claimant receive a confirmation from the insurance company. The insurance company verifies the treatment and specifies the amount approved.
  • The claimant can present the health card at the hospital on the day of the medical procedure; after that, the insurance company takes care of the medical bills cashlessly.

Emergency Hospitalisation

In the event of a sudden need for medical attention or hospitalisation, the claimant needs to follow these steps: 

  • The insurance company must be inform within 24 hours of hospitalisation via email or any other contact procedure.
  • The claimant must produce documents like policy copies, insurance cards, customer ID proofs, and a customer KYC form.
  • The hospital then has to file a cashless insurance form and submit it to the insurance company.
  • Once the insurance company verifies all the documents and is satisfie, it will send an authorisation form to the hospital and eventually pay the medical expense bill.  

Reimbursement Claim Process for Health Insurance

In some cases, the medical establishment might not be part of a cashless network, so the health insurance company might be unable to provide the cashless method. In this case, the claimant will have to pay for the medical bills from their pocket, and then the india best health insurance policy company will reimburse the claimant at a future date. To have a seamless claim process, you have to keep certain things in mind while filing the reimbursement claim, which is as follows:

  • The claimant must verify the billing process and ensure all medical expenses are appropriately mention on the medical bill.
  • Get a claim form from the insurance company. It can be obtain from the website of the insurance company.
  • The claim form will have additional instructions regarding certain documents that need to be produce.
  • The document mentioned above list varies by the insurance company, but some of the most frequently requested documents include medical certificates, pathology reports, original bills and receipts, a duly completed Customer KYC form, and so on. 
  • Review all the documents carefully, since a discrepancy can cause unnecessary delays.
  • Make a copy of the claim form and all the documents before submitting them to the insurance company.
  • Once the insurance company has verified all the documents, it will begin the reimbursement process.

Providers such as Niva Bupa Health Insurance provide a quick and easy process to file health insurance claims, be it cashlessly or via the reimbursement procedure. If you are looking out for India best health insurance policy, you should check things such as an easy claim process, claim settlement ratio, customer service etc.