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All about Medical Insurance Claims

It is best to buy medical insurance from a company that has a flawless claim settlement record. You can look for claim settlement ratios online. However, what is even more advisable is to have a clear understanding of what your policy covers and excludes. Assess your lifestyle, driving habits, present health, and only then choose a cover. After all, when there is a medical emergency, the financial aspect is a huge burden and should be taken care of with ease.

Things to Know About Medical Insurance Claims

You would not want to go through long procedures at the time of hospitalization or during convalescence.

Read the following to know everything about medical insurance claims:

When is a claim supposed to be filed?

Medical insurance covers expenses that arise from the ailments it covers and that are admissible under the policy. You will need to file claims for expenses when you incur hospital charges such as for room, boarding and operation theatre costs, fees of the doctors, nurses, anesthetists and surgeons, and procedures like diagnostic tests, medicines, oxygen, pacemakers and so on.

What documents are required for filing a medical insurance claim?

The documents that you will have to keep handy for successfully realizing a claim are:

  • Claim form, properly filled and duly signed
  • Prescription form necessitating hospitalization
  • Discharge certificate issued by the hospital
  • Medical reports
  • Final hospital bill and receipt of payment of the same
  • Medicine bills and corresponding prescriptions
  • Other bills/invoice for implants (if applicable)

In a critical care policy, documents for claim realization would include claim form duly filled and signed, reports concerning diagnosis, reports by the attending physician on the patient's past medical record, and the first consultation document.

What are the types of claims that can be filed?

Reimbursement claims: If the insured has already paid for the treatment costs, having been hospitalized, they can file a claim with the medical insurance company for the reimbursement of the amount paid. The insured can file for reimbursement claims only if the treatment is at a hospital that is included in the policy.

Cashless claims:

These do not require the insured to pay the expenses incurred at the hospital. The insured can approach the TPA desk of the hospital with the insurer's health card, a photo ID and the necessary documents. The hospital will be paid directly by the insurance company.

It is always necessary to preserve all receipts and organize them in a chronological order. This applies also to medical reports and all policy documents in order to successfully file a medical insurance claim.

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