How to file a health insurance claim

By  ,  Onlymyhealth editorial team
Feb 01, 2013

You might have made an intelligent move by getting a health insurance, but you must also know how to file health insurance claims. Claiming health insurance can put you in a catch 22 situation and therefore it becomes essential for one to know – How to file a Health Insurance?

Your insurance claim begins even before you take an appointment with your doctor. In this regard it’s important to understand what plan of action is to be employed in case of planned and unplanned hospitalization.


Planned Hospitalization

•    Contact the third-party administrator of your health insurance policy.
•    Verify the coverage terms.
•    Make sure the hospital falls under the network of hospitals of your health insurance.


Unplanned Hospitalization

•    Ask the third-part administrator to get you the claim forms.
•    Understand the procedure of filling the claim.
•    Find out what pre and post-hospitalization expenses are covered under your policy.
•    Settle the bills out of your pocket and claim for reimbursements.
•    Attach necessary documents with the claim form and send it to your health insurance provider within a set period of time.

Read the points listed below to successfully claim health Insurance


Know Your Coverage

It is not essential for you to memorise your health insurance policy but always make sure you know both, that is, expenses that will be covered and excluded.


Obtain itemized bills, receipts, cash memos


Health insurance companies generally ask for detailed bills against every service that your doctor provided at the hospital. Make sure that you ask the doctor to provide you with itemised bills to avoid delay in claiming health insurance. Always attach the itemised bills with the claim form. You must have the following with you:

•    Certificates from medical practitioner.
•    Doctor’s certificate mentioning nature of the operation performed.
•    Consultation history.
•    Diagnostic test reports.


Fill out your health insurance claim form

Download or ask for a copy of the claim form. Usually, there is additional information about documents required. You must give it a thorough read and fill out the required details.


Keep a copy of the Claim form

Make it mandatory to keep copies of your claim form and every additional information provided to you health insurance company. This would never allow any scope of error to surface and prevent quick reimbursements of expenses, in case your insurance claim gets lost.


Review and stay informed


•    You must review your form and inform your health insurance provider that you’re sending them the claim form.
•    Ask them how long you’d be required to wait for claim payments.


Send the claim form


Send the claim form and keep a check on the date you are to receive the claim money. If payments are delayed you can always get back to the particular health insurance company and seek valid explanation.


If you keep in mind the points mentioned above, you would experience a hassle free claim procedure if you supervise it in a disciplined manner.



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