To claim health insurance during an emergency, notify your insurer immediately, provide necessary documents, and follow the claim process given in this guide.
Accidents and illnesses do not choose a time or place before affecting us. As such, the absence of a health insurance policy may lead to an unexpectedly high financial burden. Whether it is an accident, a sudden illness, or any other form of medical emergency, knowing the steps to claim your medical insurance policy can be of great help. In this blog, you will get all the information you require to know how to properly and swiftly make a claim on your health insurance in case of an emergency.
Knowing details about your health insurance policy well before any emergency is important. Understanding your policy can help you save time when it comes to filing a claim.
Here is a step-by-step procedure you can follow to claim your health insurance during an emergency:
In case of an emergency, the first thing you should do is to look for medical help. Whether it is driving to the nearest hospital or dialling the emergency services, it is important that the patient gets the attention needed as soon as possible.
If the circumstances permit, it is better to be admitted to a network hospital that is associated with the insurance company. Network hospitals provide cashless treatment; that is, you do not have to pay the bills yourself, and the insurance company will pay the hospital directly.
As soon as possible, report the emergency to your insurance provider. Many insurers provide a helpline number for reporting claims, and it is mandatory to report the claims immediately. Delaying to inform the insurer may lead to rejection of the claim, or if accepted, may take longer time to process.
At the hospital, there is a form that you have to fill out at the hospital’s insurance desk, which is known as a pre-authorisation form. This form provides information about the patient, the nature of the emergency, and the estimated cost of treatment. This form will be forwarded to the insurance company by the hospital.
Along with the pre-authorisation form, you may need to provide additional documents such as:
It is advisable to have these documents and submit them to the authorities as early as possible so that the approval process is fast.
After the insurance company has gone through the pre-authorisation form and the other documents that the patient submits, they are likely to either approve or reject the request for cashless treatment. If approved, the treatment can go on without you being charged any amount of money at the beginning. However, there may be co-payment clauses or sub-limits in the policy, which means that you have to pay a certain amount for the expenses.
Sometimes, you may be admitted to a non-network hospital, or your cashless claim may be rejected. In such cases, you will have to use your own money to meet the bills and then seek an expense reimbursement. The following documents are typically required for a reimbursement claim:
Once you have filed your claim, it is advisable that you keep on following up with your insurance company on the progress of your claim. Some of the insurers may ask for more information or clarification, and therefore, one should be willing to attend to their needs. It is important to keep copies of all communications for future use.
Dealing with a medical crisis is never easy, but knowing all the ins and outs of how to go about filing a claim for your health insurance can make it a little easier. By reading through this guide and making sure that you understand your health insurance policy, you can concentrate on the most important thing, which is getting the right medical attention you need. In this way, you can ensure that your medical insurance policy is a good safety net when you need it.
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