How to File Health Insurance Claim

Health Insurance is the entitlement that is availed against medical expenses when the individual falls sick or meets with an accident. Cashless facility will not be provided by the hospital authorities if the claim form is not filled out properly by the claimant. Health Insurance claim can be a very tedious process when there is no help from the healthcare provider. So, it is very essential on the part of the claimant to take the following necessary steps:

  • Itemized bill should be obtained from the doctor or from the hospital. An itemized bill provides the cost of each of the services that has been provided by the doctor as well as the hospital. The claim form is then attached to the itemized bill by the Insurance Company.
  • The Health Insurance claim form which is generally self explanatory in nature has to be filled out. The claim form mainly asks for the Insurance amount assured, to whom the claim is to be made and what is the type of compensation that is asked for, etc.
  • There are two types of Health Insurance plans—one is the indemnity plan and the other is the Preferred Provider Organization (PPO) plan. The client can choose between any of the two plans.
  • Copies should be made of all the Insurance documents and the itemized bills for refilling of the claims process in case of any discrepancies or in the case of form getting lost.
  • The Insurance Company should be immediately contacted if the client does not receive the claim within the specified time frame.
  • The expenses that are incurred on hospitalization should be claimed by the client only after the patient gets discharged from the hospital or on completion of the full course of treatment.
  • While intimating for the claim the following information must be kept ready by the claimant:
    • The Policy number of the client
    • Contact details of the claimant
    • Name of the person hospitalized
    • Relationship of the claimant with the person who is hospitalized
    • Name of the Hospital
    • Name of the ailment
    • Nature of the accident (for accident claims)
    • Date and time of the accident (for accident claims)
    • Location of the accident
    • Diagnosis date of the ailment
  • Client should always do some research on the type of Insurance that is being bought as the Insurance company only pays for the benefits one is covered for. The policy should be thoroughly read to cover any diagnosis that requires treatment.
  • Payments made by the Insurance Company to the claimant are deposited on the client’s account electronically. Any denied or rejected claim should be thoroughly checked and the proper course of any action should be taken for reimbursement.
  • Third party services may be approached for accurate and timely healthcare claims. The third party services help the client with the state-of-the-art electronic claims process which helps in easy retrieval of the claim.