Many of us face hurdles while claiming expenses from health insurance policy. Company delaying the claim due to unexplained reasons and hospitals demanding a cash deposit in cashless claims are few of the common situations we come across. The concern are much higher when you are hospitalized and your family members has to run from pillar to post to get the claim settled. In worst scenario you have to won your claim from consumer court.
Having said that unawareness on our health insurance policy limitations and the claim procedures can also bring hurdles. Delaying intimating the company, missing out on required documents and many other factors can be the reason of our claim getting delayed or rejected at times. As a policyholder we have to understand our policy and claim procedure in detail so that we can avoid undue hazzle for us and our family members.
Here are 6 steps on which you should focus and ensure the process of your health insurance claim is easier:
1. Read The Policy Wordings
Most health insurance plans have sub-limits on hospital expenses and co-payment clauses in different cases. These sub- limits actually limits your claims. One of the larger reason of hospitals asking for additional deposit is the presence of sub-limits in your policy. The policy wordings of the product will speak about these limits as to when they are applicable and what is the company liability. By going through these wordings you can be well informed under what conditions you may be be denied a claim or will have to bear the expenses.
2. Read The Claim procedure
Every company highlights the claim procedure in their policy documents. This will generally contain the time horizon within which you need to inform, the time horizon for submit your documents when claiming for reimbursement, the list of documents company will require to process your claim and the contact numbers where you need to be in touch for the claim process. You should take note of this claim procedure and let your family be aware of it. The contact numbers should be with you so that you can call up the company when needed.
3. Secure All Documents
While any of the family member is treated it is necessary that the documents of all expenses are secured with you. This is specifically required for reimbursements as you will have to submit these documents for the claim. Doctors prescriptions before the treatment, medical bills, hospital bills which include all test and cost of treatments, doctors report on the treatment, doctors prescriptions of post treatment medicines and test, medical bills post treatment and all such expenses which you have incurred. If any of the bills are missing from the documents the company will not fulfill the claim for that particular expense. Also if your documents are well in place the company will be liable to process it in time.
4. Previous Years Policy Documents
At many instance we have come across situations when during claim the insurer/TPA asks you previous years policy documents. This situation arises mostly in cases where TPA of the insurer have changed. In general most of us do not store old documents but considering such instances it will be wiser to keep with you previous years policy documents so that the claim do not get unnecessary delayed. You can even store electronic copies instead of physical documents.
5. Communicate With Company
Once you have submitted your documents it is very important that you keep communicating with the company to know the status of your claim. Many of them now update the status online which you can view. Any requirement is sent to you electronically and updated online. So if you are monitoring the updates you will come to know when this requirement has arrived and you will be able to fulfill it sooner.
6. Escalate on Delay
There are many instances where company executives delay the claim process. If your claim is also being delayed you should be escalating the matter. The more you do it the more it will force the company to resolve it sooner. If you are well aware of whom to escalate and how you can do it then it will do good for you .
7. Notify Within Time
It is also your duty to inform the company within the stipulated time to settle your claim. In a recent case the court rejected the plea because the claimant took five months to notify the company about expenses. For cashless it is more important since there are many authorizations which hospitals take from the company to continue with the treatment. Although hospitals themselves have the process wherein they let you fill the authorization form but if you are proactive you can lessen the time for this process and save any undue delay.
8. Keep Some Cash with You
Even though you may have a cashless policy, it is ideal that you do not be dependent on it and have some cash with you. This is primarily for the reason that at times your policy SA may not be enough for the hospital cost. Based on the level of hospital their cost varies but your policy value remains the same. Any escalation in the cost will have to be taken care you for which you should have some health fund lying with you.
We all desire to have smoother claim process. But you should be well informed of the procedures so that you can benefit from it. Understand it when you are availing the policy for your family. Your awareness and your actions will help in speeding up the claim when required. If needed take the help of a professional to be clear on claim settlement.
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