Understanding the Claim Process for Family Health Insurance Plans : The Tribune India

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Understanding the Claim Process for Family Health Insurance Plans

Understanding the Claim Process for Family Health Insurance Plans


Having the best health policy for family is essential to ensure the well-being of our loved ones and can offer a sense of security. Family health insurance is becoming more needed than a luxury in areas with rising medical costs. However, even with insurance, the cost of medical treatment can still be a burden on one's finances. This situation is where healthcare insurance claims come into play.

This article will teach you about family health insuranceclaims and how they work.

  Types of Healthcare Insurance Claims

A healthcare insurance claim is a request made by the policyholder to the insurance company for compensation for the expenses incurred for medical treatment. Whether it's a major surgery or a routine check-up, a health claim can help ease the financial burden of medical costs. There are two kinds of claims for medical insurance:

1.   Cashless Claims

These claims are a popular way of claiming medical insurance benefits. In cashless claims, the policyholder doesn't have to pay the hospital bill directly. Instead, the insurance company settles the claim directly with the hospital.

This option is available only if the policyholder visits a network hospital where the policyholder can receive medical treatment without worrying about the payment process if they see a network hospital. There are two methods for requesting cashless claims.

Cashless Process For Planned Admission

Here are some steps for the cashless process for planned admission

  • Choose a network hospital: The first step is to choose a hospital within the insurer's network. You can find a list of network hospitals in your insurance document or on the insurer's website.
  • Inform the third-party administrator (TPA): You must inform the TPA (third-party administrator) at least three days before your planned admission. Provide your membership number and other necessary details.
  • Fill out the cashless request form: Once you reach the hospital, you must fill out the cashless request form available at the insurance desk. Provide your personal and health insurance policy details and a summary of your medical condition.
  • Submit the form and medical records to TPA: Now submit the cashless request form and medical records to the TPA for inspection. The TPA will verify your policy details and medical condition.
  • Approval and settlement of bills: The insurance company will settle the hospital bills directly if they approve the cashless request. If the insurance company denies the request, you can request the reimbursement form by submitting the original invoices and medical reports.

  Cashless Process For Emergency Admission

Now, let's take a look at the process for emergency admissions:

  • Inform the TPA: In case of emergency admission, inform the TPA and provide your membership number as soon as possible.
  • Complete the cashless form at the medical facility: Once you reach the hospital, complete the form certified by a doctor.
  • Send the application and the medical records to TPA: Submit the cashless form and your medical records to the TPA for verification.
  • Approval and settlement of bills: If the insurance provider rejects the request, you can choose reimbursement by submitting the original receipts and medical records.

2.   Reimbursement Claims

If you choose reimbursement, you must first pay your costs. Cashless claims may be more complicated. Medical assistance is not limited to hospitals in your network. Choosing a hospital is your choice.

  Reimbursement process for the claims

By following these steps, you can successfully make a reimbursement claim with your insurance company.

  • Contact your insurance company: To begin the reimbursement process, contact your insurance provider immediately. You can call the toll-free number in your policy documents. When you speak to a representative, provide your membership number so they can locate your policy and assist you more efficiently.
  • Settle all the hospital bills: If you or a family member has received medical treatment, you will likely have to pay the bills upfront. Make sure to settle all the hospital bills before proceeding with the reimbursement claim process. Keep all the receipts and bills safe; you must provide them as evidence later.
  • Gather necessary documents: You must provide certain documents to your health insurance company to make a reimbursement claim. These documents include bills, prescriptions, discharge summaries, and other relevant medical records. Make sure to collect all the necessary documents before proceeding with the claim.
  • Download and fill out the reimbursement form: Most insurance companies have a reimbursement claim form that you can download from their website. Fill out the form completely and accurately; any mistakes or missing data might delay the refund process. Also, be sure to include all essential papers with the form.
  • Submit the form and documents: Once you have completed the reimbursement form and attached all the necessary documents, please submit them to your insurance company. You can mail them to the company's address or submit them online through their website.
  • Wait for approval: After you have submitted the reimbursement claim, the insurance company will review the documents and verify the information. If everything is in order, they will process your claim and send you a check for the amount owed. The average time for this process is roughly 20 days from receipt of all the documents.

To have your medical insurance claim approved, carefully follow these instructions.

Remember, your health is your most valuable asset, and a family health insurance policy can help you safeguard it against unexpected medical expenses. With proper knowledge and careful planning, you can make the most of your health policy and avail yourself of its benefits. If you want to have health insurance for family of 4 ormore members, you can contact NivaBupa for the best health plans.

 

 

Disclaimer : The above is a sponsored article and the views expressed are those of the sponsor/author and do not represent the stand and views of The Tribune editorial in any manner.


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