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5 things to watch out for when filing health insurance claim
The insurance company lives with the lurking fear of being trapped in fraudulent activities. And therefore, they follow the strict evidence checking rule in the claims process. Only when the insurance company is satisfied with all the evidence and proof, they will allow the claimant to get out of the line of fire.
You don’t need to find an escape route as you are not fraudulent instead you need to know how to get out of the line of fire like a hero. To know-how, read the 5 things to watch out for when filing a health insurance claim below:
1. Duly filled claim form
A medical claim form is an application form that every insurance company demands to start the claim process. Generally, the claim form comes with two sections Part A & Part B. Part A includes A to G sections that need to be filled by the claimant and Part B is filled by the hospital. Part A of form informs the insurer about the incident, medical expenses, and details of the policyholder and dependent who needs coverage, details of hospitalization, and a checklist of documents that one needs to submit with the claim form to the insurer. To avoid mistakes, fill the medical reimbursement claim form with the help of the SureClaim expert.
2. Intimation & claim within the time limits
The insurance company expects the insured to intimate the insurance company about the hospitalization 3 days before for planned hospitalization and within 24 hours in emergency hospitalization. Once the intimation is done, you can file a claim within 30 days from the date of hospitalization. On exceeding this time limit, you will have to submit the reason for the delay with your claim, failing which your claim can get delayed.
3. Whether treatment is covered or not
Having a health insurance policy doesn’t mean that you can claim any medical expenses arising out of any medical conditions. Every health insurance plan comes with certain limitations mentioned in the terms and conditions of the policy. Before filing a claim, you must read the policy wordings which include the exclusion list and all the terms and conditions of your policy. Claim filed for anything that falls under the limitation or exclusion list will be rejected by the insurance company.
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After filing a claim form, you need to submit the documents as evidence and proof of the incident. The documents should be in the order that it should include the first consultation letter to all the medical bills related to medicine, hospitalization, lab reports and for which you are covered under the policy. The documentation process plays a very crucial role in your claim process as the entire decision of approval depends upon the documents you have submitted to your insurer. When people fail to justify the medical expenses by not submitting the supporting documents, the insurance company raises query which makes the process complex and time taking. It is important to note that all the supporting documents are to be submitted in original to the insurance company.
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5. Submit it to the right address
Now when you are ready with your duly filled claim form and all the supporting documents, it is time to verify the correct address of your insurer to send your claim. This point might sound obvious but let me tell you insurance companies have a specific address to receive the claim and process them. Make sure you find the correct address and send your claim via mail or submit by hand to the right address.
Insurance companies take somewhere around 5 to 7 weeks to process your claim. Wait, your job is still not complete, you will have to do a regular follow-up of your claim with your insurer. First, you will have to verify if the insurance company has received your claim. Second, you will have to follow up for your claim id, which is usually generated by the insurance company within 3 to 4 days after receiving your claim documents. Third, take regular follow-up with your insurer for your claim status via call or online.
About the author
Anuj Jindal co-founded SureClaim to fix the broken claim experience of insurance customers. He believes technology can play a major role in empowering customers. His understanding is shaped by his decade long stint in healthcare and health-tech companies.