PNN
New Delhi [India], May 30: Submitting a health insurance claim might sound overwhelming if you are already in the midst of an illness or recuperating from your stay in a hospital. However, with a little foresight and the correct information, all of this can be managed seamlessly, without you having to run to collect papers or make phone calls. This guide aims to take you through the process step by step in a clear and simple manner for both cashless claims as well as reimbursement claims.
Now, let us look at both routes (cashless claims and reimbursement claims) and how an ACKO insurance simplifies both without the hassle.
Understanding What’s Covered and What’s Not
Before you even think about filing a claim, it’s important to know what your health insurance policy includes and excludes. Policies have limits, beyond which they cannot go. Sometimes, certain treatments aren’t included, and you might have to wait before receiving help for specific conditions.
Also, remember to scan the list of hospitals linked to your insurance company. This step is necessary if you’d like to process your claim without cash. A hospital in the insurer’s network is the only place you can use a cashless service. If you require surgery in advance or in an emergency, select a hospital from the list given here. It will prevent you from wasting your time, being short of money and dealing with a lot of paperwork.
Cashless Claims
Cashless claims are a blessing when handled right. You don’t have to run around collecting bills, you avoid paying huge sums upfront, and the insurer settles the eligible amount directly with the hospital.
Step 1: Reach Out Early
The moment you know that you will be admitted to a hospital, or if it is an emergency and you go to the hospital, inform the insurance desk at the hospital. You will have to directly contact the Third-Party Administrator (TPA) or your insurance company.
They will send you a pre-authorisation form, which is basically asking you if you give permission for the claims process to begin. In the current phase, you will be required to show your Cashless Health Card and an ID proof.
Step 2: Get Approved and Admitted
As soon as your pre-authorisation form is arranged, the insurer has to check all of the details, after which it will send the requisite approval to the hospital. In short, this means treatment can begin, and you would not have to worry about the payments at least for the treatment and its associated expenses.
Reimbursement Claims
Sometimes, you might end up getting treated at a hospital that’s not in your insurer’s network. In such cases, a reimbursement claim is your go-to option. The idea here is simple: you pay the bills, submit the documents later, and the insurer refunds the amount as per the policy.
Step 1: Inform Your Insurer
It also makes sense to let your insurer know when you are hospitalised even if you are sure that you would want to make a claim for reimbursement later. This would assist in establishing documentation and expedite the process of assessing claims at a later stage. Maybe email or call them to register the event.
Step 2: Gather and Organise All Documentation
If you are discharged, please ensure that you have collected all documents. These are the claim form duly filled, hospital bills, discharge summary and prescriptions, diagnostic reports and payment receipts. This paperwork will become the basis of your case.
This is where it gets a little easier, well, most insurances nowadays allow you to download your claim form straight from their website.
Step 3: The Bills After Hospitalisation
Also, remember that post-hospitalisation treatments are also covered by many policies. Save and submit these bills. Certain insurers may ask for a fitness certificate or follow-up reports, too. Once all this is aligned, your claim gets approved in a few weeks and the eligible payout is directly credited in your bank account.
Selecting the Right Insurer
Your insurer often shapes your experience during a claim. Some companies offer quicker processes, fewer documentation requirements, and better support. For example, ACKO General Insurance offers health policies with zero waiting periods, 100% bill payment on approved claims, and the convenience of a fully digital process.
Wrapping Up
Filing a health insurance claim doesn’t have to be confusing or frustrating. The key lies in knowing your policy, staying organised, and keeping your insurer in the loop right from the start. Whether it’s a planned hospital visit or an emergency, these steps can help you get through the claims process without feeling overwhelmed. Remember, your health insurance is there to support you, not add to your worries. A little preparation can make all the difference when you need it the most.
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