Can A Request For Cashless Claim Be Rejected/ Repudiated?

How to get reimbursements in case of treatment in non-network hospitals or denial of cashless facility?

Reimbursement of your claim can be obtained by applying for reimbursement facility after the treatment is done. Below are the steps to avail reimbursement claim from your health insurance provider.

Step 1: Intimate the insurance company regarding the claim and take a note of the “Claim reference number”. Fill the claim intimation form with the maximum details which form the first hand information provided by the customer regarding hospitalization.

Step 2: Submit all the necessary documents for claim processing which include:-

• Duly filled and signed original claim form.
  
• Valid Identity proof and address proof
  
• Doctor’s prescription advising diagnostic tests, medicine and consultation
  
• Original pharmacy bills
  
• Diagnostic tests, surgery bills and consultation as prescribed by the treating doctor
  
• FIR as required
  
• Ambulance receipts
  
• Any other document required to assess the claim
  

What is a Health Card?

A health card is a card that comes along with the health policy which is similar to the identity card. This health card can be used to avail cashless hospitalization facility at any of the network hospitals. A health card mentions the name, age, contact details of the insured and the contact details of the TPA. In Case of emergency the insured customer can reach out to the numbers mentioned in the health card. E-health card can also be downloaded from the website and used for cashless hospitalization at any of the network hospitals.

What is Cashless Health Insurance?

A cashless Health Insurance policy is a policy in which the hospital costs are covered directly between the insurance company and the network hospital. No cash has to be paid by the insurance policyholder.

What is Cashless Hospitalization?

Cashless hospitalization is the process in which in the insured would get admitted in the hospital for treatment and the costs would be borne by the insurance company. The hospitalization cost would be paid to the hospital by the insurance company directly without the intervention of the customer. For this the insurance companies discuss packages with the hospitals and fix a price for a particular type of treatment. Cashless hospitalization is the best mode of claim settlement in a health insurance policy as the rising hospitalization costs are posing a serious threat to the people and causing a huge dent in their savings during hospitalization.

How many times can I claim in a Health insurance policy?

You can claim any number of times in your health insurance policy as long as the sum insured is not exhausted. The sum insured in your policy is the maximum limit which can be utilised by you for claiming any number of times. There is no limit on the number of claims that can be made in your health insurance policy.

Will my premium increase if I make a claim?

Health insurance premium are dependent on the age of the prospect and the coverage selected. But in some cases the health insurance premium could be increased at the time of renewal due to the heavy claim ratio that the insurance company has incurred over the past year. It means that the claims paid exceed the premium collected by the insurance company.

Why not I take a Top UP Policy instead of New India’s Mediclaim Policy?

A top up policy is an additional coverage for people already having an individual health insurance plan or employer health insurance policy. It is useful in case of a single illness which consumes the entire sum insured in the base policy. The top up policy triggers only after the sum insured in the base policy is exhausted and the deductible under the top up is crossed due to hospitalization. Having a top up policy without a base health insurance policy is like having a bike without an engine. A top up policy has a deductible amount which would be almost 20% of the top up policy sum insured. For example let us take a base policy with Rs.2 Lacs and Top up policy with Rs.5 Lacs, in case of hospitalization first the base policy sum insured will be utilised and then the top up policy kicks in.

Will the entire amount of the claimed expenses be paid?

In any health insurance policy, the amount settled by the insurance company would be the claim amount incurred or the sum insured mentioned in the policy whichever is less. The maximum liability of the insurance company in case of claim would be the sum insured mentioned in the health insurance policy copy. There are certain expenses which are incurred during hospitalization such as Laundry expenses, food expenses which are not paid by the insurance companies. Consumables expense is paid by certain health insurance policies, consumables include gloves, hand wash, sanitizers etc. The claim amount paid by the insurance company varies from case to case and it can neither be agreed nor denied that the entire claim amount being paid in case of hospitalization.

how to claim medical insurance?

To claim medical insurance, follow these general steps:

• Inform the insurance provider: Notify your insurance provider about the medical treatment or expenses you need to claim as per their specified process, which may include phone, email, or online claim submission.
• Gather necessary documents: Collect all the required documents, such as medical bills, prescriptions, discharge summaries, diagnostic reports, claim forms, and any other supporting documents as per your insurance provider's requirements.
• Submit the claim: Submit the claim form along with the supporting documents to the insurance provider within the stipulated period. This can usually be done online or by mail, depending on the insurer's process.
• Review and follow-up: Once the claim is submitted, the insurance provider will review the documents and may request additional information if needed. Follow up with the insurer for any updates on the claim status.
• Claim settlement: Upon approval, the insurance provider will process the claim and reimburse the eligible amount as per the policy terms and conditions. If the claim is denied, seek clarification from the insurer and provide additional information if required.