Planning to get some diagnostic tests done? Or has your doctor recommended hospitalization or surgery? Wondering as to how to claim your health insurance to take care of all these expenditures? Continue reading to get step-by-step guidance to understand the entire health insurance claim process. The health insurance claim process varies depending upon the scenario: 1. Cashless settlement in case of planned hospitalization:
Before selecting a hospital, make sure that it comes under the list of PPNs (Preferred Provider Network) or network hospitals of your insurer to avail the cashless settlement
The cashless settlement process must begin 48 hours before the hospitalization or within 24 hours of the hospitalization in case of an emergency
Before making the claim, don’t forget to check whether the ailment or treatment is covered by your policy or not
During the admission, fill the pre-authorization form at the billing counter and give it, along with your ID/ address proof and your cashless health insurance card to the TPA (Third Party Administration) section in the hospital
The TPA will take care of the rest, and henceforth will act as a mediator between you, the hospital and the insurance company
Do take a copy of the hospital records and the bills as the insurance company is entitled to possess the originals of these documents
2. Reimbursement in case of the hospital not being in a network hospital and in case of pre and post hospitalization expenditures:
This means initially you will have to make the payment and later on, you will be reimbursed the amount by the insurer
Get in touch with your insurer who will give you a reimbursement claim form. The filled form, along with the original copies of all the medical bills, test bills and hospital bills (duly stamped and signed by the hospital authorities) has to reach the insurer within 30 days after being dispersed from the hospital
the documents should also include the prognosis prescription and the discharge summary
the prognosis prescription should clearly state that the patient needs hospitalization, the patient name, hospital’s registration number, date, etc.
the discharge summary should clearly state that the patient is fit and healthy after his stay in the hospital
the post-hospitalization expenses (follow-up checkups, doctor visits, medicines, etc.) can be claimed from the insurer only within 60 to 120 days from being discharged. The time period may vary from insurer to insurer
Don’t forget to keep a copy of all the aforesaid documents and you should get your money reimbursed within 2 to 3 weeks from your claim being registered
While purchasing a health insurance always choose a company like Cigna TTK that provides you with a hassle-free and swift health insurance claim process and also a wide range of network hospitals to choose from. Get your health insurance from Cigna TTK today:
Call/Whats app - 00971 50 765 0356
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