Health insurance: Claim process at a non-network hospital

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Health insurance plans are in high demand as the policy holders receive cashless medical assistance at hospitals. However, it’s important for you to examine the list of the network hospitals covered under your insurance policy, before you buy it. A network hospital in your vicinity is always helpful and convenient at the time of need. Many people face problems at times when they don’t have access to a network hospital as per their health insurance provider and they seek treatment at a non-network hospital.

In such a situation will your health insurance come to your rescue? Yes, you can use your health insurance coverage but the process could be cumbersome at times.

A large number of hospitals and clinics have joined the network of health insurance companies and the list is gradually growing. These networked medical establishments offer lower-cost services to policyholders. In exchange, these hospitals and clinics receive a steady stream of patients who are covered under different health insurance plans.

When a person covered under a health insurance plan is admitted to a non-network hospital is expected to pay the entire bill. Later the treatment cost can be claimed under the policy. The insurance companies settle the claims after due verification of all hospital bills and documents. The process may take 10-12 days or even longer in some cases.

Documents required

Non-network hospitals are also covered under the health insurance policies and you need to submit relevant documents to file your claim. Keep these documents ready for a hassle-free settlement of your claim under the health insurance plan.

(i) Claim Form duly filled and signed by the insured person

(ii) Original or photocopy of discharge summary

(iii) Original hospital bills

(iv) Prescriptions and original bills (for medicine purchases)

(v) All test reports in original (can be returned by insurer after verification)

(vi) A medico legal report (in case of hospitalization following an accident)

(vii) A cancelled cheque/copy of passbook of the insured