Claim all the benefits

Following are the points to be kept in mind:-

For Cashless claims

-           When you opt for a cashless policy, the insurance companies have a tie-up with various hospitals all over the country. So you can avail of the cashless treatment at these hospitals. You can get this list either on their websites or with the policy documents.

-           For an emergency hospitalizations, the third party administrator (TPA) should be contacted within 24hours. But if you are aware of the hospitalization then the TPA should be informed 3 days in advance.

-          Once you are admitted in the hospital you need to fill up the cashless request form and get it verified and certified by the hospital doctor.

-          After the form is completed then you need to fax the document with medical records to the TPA.

-          When the documents are received by the TPA he accordingly informs the hospital to sanction the cashless request or asks for more documents if needed.

-          On receiving the cashless facility the hospital bill is cleared by the insurance company and the policyholder does not have to bear any charges (subject to the policy limit). Only certain things like food, attendant charges or telephone calls are to be paid by you.

-          Even if you choose to get admitted in a hospital which is not listed with the insurer you can still claim or get reimbursed.

Always remember to carry your health card which mentions your membership number and is known to the TPA so you can get your cashless benefit.

For Reimbursement of claim

Reimbursement of a claim can be done at hospitals which are affiliated or non-affiliated. Once you have availed the treatment, you have to settle the bills with the hospital directly and then file a claim with the insurer. The insurer must be informed within 7 days of the date of discharge. Through the insurance company website one can inform them of the policy certificate number and the claim as well.

Following are the documents in original are to be submitted to the insurer within 30days of discharge:-

• Completed claim form with the doctors certificate

• Discharge details.

• All the bills and receipts (including any advance and the final receipts)

• Doctors prescriptions for medicines and advice for laboratory tests

• Diagnostic test reports, X-ray, scan and other films

Claims get processed once all the documents are received and if any additional document required the company will inform the policyholder. After which the cheque amount is sent directly to the policyholder. If the claim is rejected the reason for doing so is informed to the policyholder as well.

Do’ and Don’t for reimbursement claims:

• Always get the original discharge documents and reports from the hospital.

• Copies of lab reports should be kept for future medical follow-ups.

• To be on the safe side keep photo copies of all the documents before you submit it to the insurance company.

•See that the receipts you get from the hospital are clearly numbered, stamped, signed and sealed.

• All the prescriptions and lab tests should be kept carefully as these are required to be given along with the claim form.

• If you are hospitalized for a traffic accidents make sure a complaint is lodged with the police and you get the copy of the FIR.

Normally we hear that most of the claims do get rejected. This could so as there could be illnesses which are not covered under the policy. So while availing of a health policy, always confirm the inclusions or the list of diseases which the company may not cover.

Disclaimer: Please note that the information provided is collected from sources publicly available & we believe to be reliable. The website doesn’t warrant the accuracy, reliability & absolute information available on the website. Participation by site visitors or registered customers is on a voluntary basis. The policies are offered by various life Insurance & non-life insurance offering companies and Bimadeals does not seek to, either directly or indirectly, advise, offer, solicit or recommend that any person who is or proposes to become its member should purchase the Policy.

From: www.bimadeals.com