Health insurance: Things to know about reimbursement claims

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The first-time experience of claiming reimbursement for your health insurance isn’t very pleasant. It’s a long, tedious and confusing process that requires a lot of paperwork, documentation, etc. While any health issue is a traumatic experience in itself, one wouldn’t want the stress to be compounded due to delays in financial support.  Hence, you must understand the process of claiming reimbursement beforehand to avoid any last-minute fiascos.

Here are five things you should know about reimbursement claim in a mediclaim policy:

Understand the claim

Under reimbursement, the insured bear the hospital expenses and later claims for a reimbursement of those expenses within 7-15 days from the date of discharge. In case of cashless claims, the insurance company settles the bill directly with the hospital. But in a reimbursement claim, you have to take the initiative to get the money by informing the insurer and arranging all the required documents, filling up the application form and engage in constant follow-ups.

Documents required

Diligent arrangement of medical bills and other expenses along with supporting documents are required for reimbursement claims. At times, you may have to deal with a third-party administrator (TPA) for submitting these documents to the insurance company. Make sure to keep all the bills safe and get a scanned copy of them for application purposes.

Broadly these documents include the following:

-Copy of Health card

-Duly filled claim form

-Pre admission investigations and doctor’s prescription papers

-Discharge summary from the hospital

-Test reports (e.g. X-ray, scans, blood report, etc.)

-Pharmacy bills supported by respective prescriptions

-All case receipts from the hospital, pharmacy

-In cases of accidents, Medico-Legal Certificate (MLC) or FIR

-Copy of the KYC documents

-NEFT details, Contact number and E-mail ID

Strict analysis of documents

Each reimbursement claim applicant is carefully examined in order to avoid any fraud. Both the TPA and insurance companies scrutinize all the documents to double-check the authenticity of the claim.

Choose a credible insurance company

Before signing up with any insurance company, make sure to take a glance at the firm’s Claim Settlement Ratio and online reviews. Do a quick research on the company’s investors and compare the price and coverage before buying the policy. Do not go by the lowest premium rates as terms and conditions may differ from policy to policy.

Patience

Apart from all this, what you must know about any reimbursement claim is that it requires lots of patience. Make sure to not get frustrated during the process and cooperate with the TPA and insurance company to settle the claim as soon as possible.

According to IRDAI, the insurer will have to pay the reimbursement amount within 30 days of receiving the last set of necessary documents for settlement. In case of delay, the company will be liable to pay 2% interest above the bank rate to the insured person.