How to claim health insurance?

Insurance
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I’m new to health insurance and want to understand the claim process in detail. How do you file a health insurance claim, and what documents are required? Is the process different for cashless and reimbursement claims?

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If you’re new to health insurance, understanding the claim process is essential to ensure smooth access to medical benefits when needed. There are two main types of claims cashless and reimbursement . In a cashless claim , you get treated at a hospital that is part of your insurer’s network, and the insurance company directly settles the bill with the hospital—so you don’t have to pay upfront (except for non-covered expenses). You simply show your health card or policy number at the hospital’s TPA/insurance desk, fill out a pre-authorization form, and let the hospital and insurer coordinate the rest. For a reimbursement claim , you can get treated at any hospital of your choice, pay the bills yourself, and then submit a claim to your insurer for reimbursement. In both cases, you will need key documents like the claim form, doctor’s prescription, discharge summary, hospital and pharmacy bills, diagnostic reports, and ID proof.

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Yeah, claiming health insurance isn’t too hard once you know how it works. There are two ways to do it: cashless and reimbursement.

If you’re admitted to a network hospital, you can go for a cashless claim. Inform the TPA desk, show your health card, and fill out the pre-authorization form. The hospital will send it to the insurer and once approved, the bill is settled directly. You only pay for non-covered items like food or registration.

If it’s a non-network hospital, you’ll need to pay first and then file a reimbursement claim. Submit the claim form, hospital bills, discharge summary, prescriptions, reports, and a cancelled cheque. After verification, the insurer transfers the approved amount to your bank.

For planned treatments, inform your insurer 2 to 3 days in advance. In emergencies, notify them within 24 hours. Keep all documents and check your policy terms to avoid issues.