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 Are Your Legitimate Claims Rejected By Companies?

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Claim Management

Dear Visitor,

If you are facing any problem in your claim with any of company, then help is at your way.

Avail our professional claim management services and get your legitimate claims approved with our expert guidance and legal advices.

Talk to our experts panel for help over your claim process and progress.

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HOW TO FILE A HEALTH INSURANCE CLAIM ?

For planned hospitalisation:

Step 1. Choose a network hospital for treatment and finalise the dates, the treatment plan and tentative expenses.

Step 2. Call up the insurer or the TPA and tell it about the hospitalisation at least 48-72 hours prior to admission by way of a pre-authorisation request.

The pre-authorisation letter can be collected from the accounts department of the hospital. The department forwards it to the insurer or the TPA concerned.

Step 3. You have to present the authorisation letter and the photo ID card to the hospital at the time of hospitalisation. The hospital may also ask for some advance deposit, which will be refunded after discharge or approval of the claim amount. You will also have to submit KYC (know-your-customer) documents to the hospital.

Step 4. At the time of discharge you need to pay expenses which are not reimbursable under the policy.

Step 5. Get copies of investigation reports and discharge summary for own records as the original papers will be kept by the hospital.



For emergency hospitalisation

Step 1. In emergency situations some advance deposit may have to be paid at the time of hospitalisation. KYC documents are also required.

Step 2. After admission, intimate the insurer's call centre as soon as possible.

Step 3. Provide the patient's health card and photo ID proof to the hospital. Intimate the insurer or TPA about the hospitalisation by way of a pre-authorisation request with the help of the hospital.

Step 4. The hospital will send the pre-authorisation form to the TPA along with necessary medical details such as the investigation report. TPA approval usually takes four to five hours.

Step 5. Verify and pay expenses which are not reimbursable. Get copies of all reports and discharge summary for your own records as the original papers will be kept by the hospital for the purpose of claim.

We also discuss some common queries regarding planned hospitalisation. What if pre-authorisation request is rejected?: Mukesh Kumar, a member of executive management and head, HR marketing and strategy planning, HDFC Life, says, "In cases where the pre-authorisation request for cashless treatment is not approved, you still have the option of submitting the original documents to the TPA and apply for reimbursement of the amount paid to the hospital.". What if it is not a network hospital?: "If the hospital is not part of the insurer's network, you need to go through the reimbursement route, under which you need to first pay and later claim the amount from the insurer," says Kumar.

Claim process for reimbursement
-Intimate the call centre about the hospitalisation within 15-30 days of getting discharged.

-The time limit may vary from insurer to insurer.

-You will receive the claim number, which should be quoted for future reference.

-Send the claim form and all original documents to the TPA.

-If additional documents are required, the insurer will contact you, generally within seven days of receiving the claim documents.

-The insurer pays within 30 days of receiving all the documents

If the hospital is not part of the insurer's network, you need to first pay the hospital and later claim the amount from the insurer

Tips for speedy settlement
-Inform the insurer on the toll-free number

-Mention the claim number or the health card number or the policy number in all correspondences.

-Carry your health card, ID proof and KYC documents to the hospital

-In case of planned hospitalisation, make a preauthorisation request for cashless treatment in advance

-For reimbursement, submit all the documents in one go

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Claim Management