Claim Procedure

Claim Procedure Medical or health insurance helps our family from falling into any financial crisis due to medical emergency. These policies cover the medical and hospitalization expenses of the insured person during the treatment period and his dependents after his death. Accordingly there are different procedures to claim the expenses.

1. Cashless claim: To obtain this facility one needs to know the list of network hospitals that offer the medical services the insured requires. This list should be enclosed in the purchased policy.

Once this is done during any medical treatment or hospitalization the insured only needs to sign the bill and the concerned hospital would settle the amount with the insurance company with which it has tied up and from where the patient has his/her policy.

Cashless claims are of two types, planned claim and emergency claim. In planned claims the doctor at the hospital with which the insurance company has tied up has to be consulted and the required expenses for the treatment has to be put in a particular format and forwarded through the hospital authorities with the assigned doctor’s signature. This has to be done at least 48 hours prior to the date of hospitalization to avoid any kind payment in the form of security by the patient or his family.

In case of emergency claim, when an insured meets with a sudden accident or has to be hospitalized immediately, he/she may approach the nearest hospital or one of the network hospitals and inform the insurance company immediately. After the treatment the insured signs the medical expenses bill which is settled by the insurance company on behalf of the patient or the hospital can claim the amount from the insurance company. For both the above procedures most of the insurance companies provide a cashless card which helps the insured from unnecessary hassles through insurance agents.

Reimbursement procedure is the second type of settlement process. In the process the insured has to avail treatment from one of the network hospitals and settles the hospital bills. Then call on the insurance company or third party and inform them about the hospitalization and submit all the documents required to claim the amount. Once this is done the insurance company will settle the amount within a couple of days. In this process it is important for the patient to have the original copies of bills, report and document for verification.

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