Health Insurance Claims

Step by Step Process for Health Cashless Claims

• Contact the Insurance Company’s Toll Free Number to report/register the claim

• Insured can get admitted to the hospital of their preference, but preferably to a network hospital of the insurance company. Kindly note that Insured person is entitled for cashless only in empanelled and network hospitals.

• Most insurance companies prefer that the insured contacts them atleast 48-72 hrs prior to admission (in planned hospitalisation cases) which will allow their claims service team to swing into action

• At the hospital you will need to show your Health Insurance card issued by the insurer along with a valid photo ID to be able to use your insurance. This will give the hospital the details they need to contact the insurer for triggering the cashless hospitalization process

• The hospital will send the insurer the necessary preauthorization request form which contains details of medical history, proposed treatment approach and estimated treatment cost. Based on the eligibility, the authorization letter is shared by the insurance company with the hospital.

• Hospital will send the final request of any pending residual amount along with final hospital bill and discharge summary. The insured be discharged upon receipt of final authorization letter from the insurer. Any inadmissible expenses, copayments, deductible will have to be paid by the insured

• Post discharge of the insured, the hospital will send the original claim documents supported by the buills to the insurer. The claim will be assessed and payment will be made to the hospital accordingly.

• In case the ailment /treatment is not covered under the scope of the policy a rejection letter would be sent to the hospital / provider at the earliest