The documentation that must be given at the time of filing a health insurance claim is a big source of difficulty for many people. However people are frequently perplexed as to what happens in the case of a cashless claim vs a reimbursement claim. There are a few things regarding health insurance claim documents that we must keep in mind.
What Documents Do I Need to File a Health Insurance Claim?
To file a health insurance claim, you’ll need the following documents:
- Filled Claim Form: The claim form, which the policyholder should fill out, must be sent first.
- Medical Certificate: A medical certificate from your doctor that has been approved by the hospital.
- Diagnosis Report: A diagnosis report with details about your health problem should be provided.
- ID Proof: To file a claim, you’ll need to include your ID proof.
- Discharge Card: Along with the claim, patients must submit the discharge card to the insurance carrier.
- Prescription And Medical Bills: The claim should include the doctor’s prescription, as well as prescription medicine bills, hospital and nursing fee invoices.
- FIR (In Case of Accident): The policyholder must submit the initial information report or the medicolegal certificate to the claim if there is an accident.
How To Make a Health Insurance Claim?
A health insurance claim might be paid in cash or through reimbursement.
1. Cashless:
There are two types of cashless claims: scheduled treatment and unanticipated treatment.
Planned Treatment: Follow the instructions below if you’re having a scheduled treatment:
1: At least four days before the therapy, notify the insurance company.
2: Besides send the insurance company a request for a cashless claim.
3: The policyholder have to send an eligibility letter to both the insured and the hospital.
4: At the time of hospitalization, provide the confirmation letter together with the cashless card to the hospital.
5: Also make sure you get the therapy you need. The insurance company will cover the expense of therapy.
Unplanned Treatment: Basically Unplanned therapy occurs when a medical emergency arises. Follow the actions outlined below in the event of an unanticipated treatment:
1: In the event of an emergency, go to the nearest network hospital and present your cashless health card.
2: At the network hospital, complete the claim form.
3: Most importantly after reviewing eligibility and coverage under the policy, the insurance company will issue an authorization letter to the hospital.
4. All you have to do now is get yourself treated, and the insurance company will cover the costs.
5. Additionally in the event of a rejection, the firm will send the policyholder a letter outlining the grounds for the denial.
2. Reimbursement Claims:
When you receive care at a non-network hospital, you may be eligible for payment.
Steps of reimbursement claim:
1: Take care of yourself in a non-network hospital and pay the cost out of pocket.
2: Submit all of the above-mentioned bills and documentation, as well as a claim.
3: If the firm determines the valid claim, the company will repaid the money spent.
4: If the claim is denied, the firm will send an explanation letter outlining the reasons for the denial.
Conclusion
It is not a major problem; many policyholders are unaware of the procedure, and insurance representatives are available to assist you. However, it is preferable to be familiar with the documentation necessary to submit a health insurance claim.
