Ensure the treatment or hospitalization is covered under your health insurance policy.
Verify the sum insured and sub-limits applicable to specific treatments or conditions.
- Obtain pre-authorization from the insurer if opting for a cashless claim at a network hospital.
- Submit the pre-authorization form and relevant medical details to the insurer through the hospital.
- Collect all original bills, receipts, and prescriptions from the hospital and pharmacy.
- Obtain discharge summary, diagnostic test reports, and consultation papers.
- Fill out the claim form accurately with all required details.
- The form should include personal details, policy number, hospitalization details, and a summary of expenses.
- Submit the claim form along with all supporting documents to the insurer within the stipulated timeframe, usually within 30 days of discharge.
- Ensure all documents are duly signed and stamped by the hospital authorities.
- The insurer will review the submitted documents for completeness and accuracy.
- They may ask for additional information or clarification if required.
- The insurer’s medical team will assess the necessity and appropriateness of the treatment.
- They will verify the expenses against the policy terms and conditions.
- Once the assessment is complete, the insurer will approve the claim and reimburse the eligible amount.
- Any disallowed expenses or deductions will be communicated to the policyholder.
- The insurer will inform the policyholder about the claim status through email, SMS, or postal communication.
- A detailed explanation of the settled amount and deductions will be provided.
- If the claim is partially settled or rejected, the policyholder can follow up with the insurer for clarification.
- The policyholder can provide additional documents or explanations if necessary to support their claim.
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