How to make a health insurance claim?

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Insurance by definition is a morbid topic. You pay for the event which you think would never happen. You therefore never make an attempt to know about the claim process in advance. This could be a costly mistake. This is because if you know details like what documents are needed and how to start the process your worries will be much lesser at the time of emergency.

Good news is for speedier and faster claim settlement, a few insurers have started settling claims online, which are generally of small amount for few treatments. For example ICICI Lombard offers AI based cashless claims settlement for health insurance policies. The AI based technology evaluates the claim and based on algorithms the amount is paid after approval.  A few medical procedures where AI is used includes Cataract, Maternity, Appendicitis, Hysterectomy, etc.

There are two ways of making health insurance claims:

Cashless   basis: For a claim on cashless basis the treatment has to be done in a network hospital. For availing the cashless facility, you need to get the authorisation first for which you need to fill in the prescribed form. You might need to pay some advance deposit at the time of hospitalisation and KYC documents along with policy number are also required. Here the insurance company directly pays to the insurer and you don’t have to wait for reimbursement.

Reimbursement basis: If you get treatment in non-network hospital then you have to pay from your pocket and later make a claim from insurance company.  There is generally of period of 7 to 15 days after the discharge during which you have to make a claim. After hospitalisation, ensure that you have kept all documents such as claim form, discharge summary, prescriptions and bills ready that are needed for submitting a claim.

Documents required for claiming from health insurance

• A duly filled and signed claim form
• Investigation report
• All original bills and other related documents
• A medical certificate , case file, etc
• Discharge card, summary report and all clearance documents
• In case of an accident or a casualty an FIR is needed

For the hassle-free and smoother claim settlement, always familiarise yourself with the claim process in advance rather than wait for a claim to arise.