A quick guide to filing claims

Health insurance claims can come across as tricky if you are not aware of how they work. Here is a quick guide to filing claims that will help ease the process for you.

Filing claims can be a tiring process while dealing with health insurance especially when you are just recovering from treatment. Most HR professionals are responsible for answering questions about filing claims and how the process works.

Quite often, insurance companies offer direct settlement which implies that the policyholder does not have to pay the bill as the hospital or clinic will receive payment directly from the insurance company. This is also known as cashless claims and is commonly applicable in certain direct settlement networks, which means you are eligible for cashless claims only at a certain list of hospitals and clinics.“Any personal items that you have purchased during the course of the treatment that were not prescribed by the doctor will not be reimbursed by the insurance company.”

Other than cashless claims, there are reimbursement claims where you pay the bill and the health insurance company will reimburse you after the treatment is complete. This can be a tedious process which is why policyholders try to avoid reimbursement claims by going to hospitals and clinics in their insurance network.

These types of claims also require preauthorization for some procedures while certain hospitals and clinics can be excluded from your network which can lead to the cost being borne by the policyholder.

Below are some tips to keep in mind before you file your next reimbursement claim:

  • The first step towards filing an insurance claim is to collect and securely store all medical reports, hospital bills, receipts and other documentation related to your treatment. Make sure to keep all the documents that you received during the 30 days before hospitalization and the ones you received 2 months after you were discharged. The medical reports must include all necessary information such as the name of the hospital, consultant, products purchased or services availed.
  • Once you have your documents in place, arrange them in chronological order in a secure file or folder. Staying organized is key when it comes to filing for claims. Make sure all documents you have are the originals and keep a copy of important medical reports as a backup. Insurance companies tend to reject claims without original documents.
  • Finally, remember to fill out the claim form with the correct details and ensure accuracy. Claims are often rejected due to incomplete or false information in the claim forms. Once ready, usually the claim form must be filed within 7 days after the completion of treatment or discharge from the hospital.

Claim forms often get rejected by insurance companies. This is because policyholders lack knowledge of items to include and exclude in their claim forms. Any personal items that you have purchased during the course of the treatment, that were not prescribed by the doctor will not be reimbursed by the insurance company. Another common reason for rejection of claim forms is non-disclosure, incorrect or partial disclosures by the policyholders. Make sure you fill in the details like age, occupation, income, pre-existing conditions and insurance policies held accurately.

Having a comprehensive knowledge of your health insurance policy and its coverage is essential for policyholders to avoid rejection of claims and contribute towards a smooth claims process. Working through a knowledgeable insurance broker helps when managing claims since the broker will work directly with both you and the insurer to ensure a smooth process.