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How to File a Health Insurance Reimbursement Claim?

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A medical emergency can happen anytime, and the hospital bills can burn a hole in your pocket. However, if you have a good health insurance policy, you can opt for cashless hospitalisation in a network hospital or choose a non-network hospital and file a reimbursement claim with the insurer.

Suppose you choose a non-network hospital for a medical procedure. In this case, you can approach your health insurance provider and claim a refund or reimbursement of your medical expenses. Read on, and we will tell you what Mediclaim policy reimbursement is and how tosubmit an insurance reimbursement claim to your health insurance provider.

What is Reimbursement Claim?

A reimbursement claim is a medical insurance claim in which you pay the hospital bills out of your pocket and then claim the same from your insurance provider. You must file for reimbursement under health insurance if you opt for a medical procedure in a non-network hospital. With this form of the claim settlement process in place, you can choose the best non-network hospital for your treatment without worrying about the bills.

How is a Reimbursement Claim Different from a Cashless Claim?

A health insurance reimbursement claim is different from a cashless claim in the following ways:

	Cashless Claim	Reimbursement Claim
Definition	A cashless claim is a health insurance claim in which the insurance provider will settle your medical bills directly with the hospital.	In a reimbursement claim, you must settle your medical bills with the hospital and subsequently file a reimbursement claim with your insurance provider.
Hospital Selection	For cashless claim settlement, you must opt for your medical treatment/procedure in a network hospital (a hospital that your insurance provider has tied up with for cashless claim settlement services)	You can choose any hospital for your medical procedure, get the treatment done, settle the bills from your pocket, and then file for reimbursement.
Claim Intimation	If you are opting for cashless claim settlement, you must get in touch with your insurance provider before the medical procedure and get your treatment approved by them.	In a reimbursement claim, you must inform the insurance company within 24 hours of hospitalisation or sooner. You must inform them well in advance if it is a planned medical procedure. In a medical emergency, you must inform them soon after the hospitalisation formalities are completed or within 24 hours of hospitalisation.
Claim Settlement	For cashless claim settlement, you must fill out the required forms in the hospital and share your ID proof and health e-card with them. The insurance provider will settle your hospital bills on your behalf. So you won’t have to shell out anything from your pocket.	You must collect all bills and other relevant documents from the hospital for Mediclaim reimbursement. You must also fill out the claim form of your health insurance provider and submit the same to them.
Claim Settlement Duration	Your cashless claim will be settled by your insurance provider almost instantly.	The reimbursement claim settlement process will start after you get discharged from the hospital and submit the required bills, documents, and claim form to the insurance company. The insurer will verify the same before settling your claim. The complete process can take 3-4 weeks.

When Should I Inform the Insurance Company About My Reimbursement Claim?

If it is a planned hospitalisation, you must inform the insurance company about the medical claim in advance. In case of a medical emergency, the family of the policyholder must inform the insurer soon after hospitalisation.

Some points to keep in mind:

• It is always wise to inform the insurance company about your hospitalisation and claim as early as possible.

• Most insurance companies want policyholders to submit their claims within 15 days from the date of discharge from the hospital. In case of a doubt, get in touch with your insurance company and confirm the same.

• Ask the TPA or insurer how to submit an insurance reimbursement claim and what documents they will require to process your claim. Collect everything and submit the same accordingly for easy claim settlement.

What are the Steps Involved in a Mediclaim Reimbursement?

The following are the steps on how to submit insurance reimbursement with your health insurance provider:

Step 1:Notify the Insurance Company

Inform the insurance company about the hospitalisation within the stipulated timeline. In case of planned hospitalisation, you must inform the insurer about the same in advance. If it is a medical emergency, the insurer must be informed soon after the hospitalisation formalities or within 24 hours of hospitalisation.

Step 2: Obtain the Documents

Get the necessary documents from the hospital and keep them in one place. You will need the following documents from the hospital to file a reimbursement claim:

• Medical certificate or doctor’s prescription in which the medical practitioner has recommended hospitalisation

• Doctor’s consultation slip

• Doctor’s prescription in which he/she has advised diagnostic tests

• Prescription for medicines

• Original pharmacy bills

• Diagnosis reports of blood tests, X-rays, etc.

• Original discharge summary

• Original receipts from the hospital

• Ambulance receipt, if applicable

• FIR, in the event of an accident

Make sure you arrange the documents date-wise or submit them in the prescribed format. Since you must submit the original bills and documents to the hospital, remember to keep a photocopy of all for your records.

Step 3: Fill Out the Claim Form and Submit it

Get the claim form from the insurance company or download it online. Duly fill in all necessary information in the form, sign the same, and submit it to the insurance company along with the required documents.

If you are not sure how to fill medical reimbursement form, take the help of your insurance agent or get in touch with the insurance company for the same. You basically have to fill in your health insurance policy number, name, address and details of hospitalisation, insurance history, claim, etc. Also, submit a cancelled cheque of the account to which you want the reimbursement claim proceeds to be credited.

Step 4: Verification of Documents

Once you have submitted the claim form and the required documents to the TPA/insurance company, the insurer will scrutinise the same before approving your claim. After verifying everything, they will either accept the claim fully or partially or completely reject it.

Step 5: Reimburse the claim amount

If the insurer approves your claim fully or partially, the insurance provider will transfer the claim amount to your bank account.

This is how to submit insurance reimbursement with your health insurance provider and get a refund for your hospitalisation expenses.

Conclusion

Although a bit tedious, the option to file a reimbursement claim helps you avail yourself of the best treatment at the hospital of your choice without worrying about the bills. When you are filing for Mediclaim reimbursement, make sure you submit all required documents in order and follow the guidelines stated in your health insurance policy. These simple yet important things will help expedite the process and prevent the rejection of your reimbursement claim.

Disclaimer: The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales.

 

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