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6 Things to Consider Before Filing Your Health Insurance Claim

Team AckoFeb 1, 2023

Like car insurance, health insurance is also meant to provide financial cushioning in case of mishaps. Unlike car insurance, health insurance is not mandatory. As a result, people often perceive it as an expense rather than a precautionary measure. This approach leaves a major part of the population without a health cover. Even, those who have a health insurance cover might not be well-versed with the details regarding raising a claim. Claim settlement is the most crucial aspect of medical health insurance for the policyholder.

Before Filing Your Health Insurance Claim

Contents

6 Things to Consider While Filing Medical Health Insurance Claim
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6 Things to Consider While Filing Medical Health Insurance Claim

1. Tenure

Mr. Suresh was admitted in the hospital as he was severely hurt after falling down from the stairs. Fortunately, he had purchased a dedicated Personal Accident Cover health policy. Being from a modest background, his family felt comforted knowing that there was an insurance policy to take care of the expenses. However, Mr. Suresh and his family were in for a shock as the insurance company refused their claim request because the policy was expired.

You must manage your health insurance actively so that you are covered all the time. An expired policy is considered as an inactive policy and no insurance company will settle a claim request raised in case of an expired policy.

2. Mediclaim vs Health Insurance

It is common to get confused regarding, Mediclaim and health insurance. Some people use Mediclaim and Health Insurance interchangeably. However, there is a difference in coverage when it comes to these policies. Whether it is a Mediclaim policy or a health insurance policy, you must be aware of the coverage and raise a claim accordingly.

Going through the inclusions and exclusions of a health insurance/Mediclaim policy will give you an idea whether the condition against which you plan to raise a claim is covered by your policy or not. If you are not sure, you can get in touch with your insurer to get your doubts clarified.

3. Terms and conditions

Merely knowing the inclusions and exclusions isn’t enough. Your claim request won’t be approved if the condition for which you are raising a claim is disqualified as per the terms and conditions of the policy.

4. Intimating the insurance company

If you are going for planned hospitalization and cashless claim settlement, it is suggested to intimate the insurance company seven days prior to hospitalization. In case the policyholder is hospitalized in an emergency situation, such admission must be notified within 24 hours for a smooth claim settlement process.

5. Reimbursement Claims

If the policyholder is admitted in a non-network hospital, then the insurance company shall settle the claim on reimbursement basis. In such cases, the policyholder needs to submit all necessary documents within 7 days of getting discharged from the hospital.

Documentation:

Claim application
Discharge card
Bills
Reports
Prescription details

6. Proper Communication

Ensure proper communication with the insurance company. Almost every claim is different in some ways. There might be certain complications in a case which do not exactly fit well with the existing process of an insurance company. Therefore, two-way communication is extremely important. You can do your part by communicating upfront with the insurance company and being patient regarding their response. Also, answer all their queries truthfully and comply with them regarding the claim settlement process.

Online Health Insurance

Nowadays, it has become extremely easy to purchase, review, renew, compare, and educate yourself regarding health insurance. All this can be done through your smartphone within minutes. Make an informed choice while purchasing the policy and follow the claim settlement process of your insurer for trouble-free claim settlement.

Also, check: Health Insurance Claim

Disclaimer: *Except for exclusions like maternity benefits, undisclosed diseases, etc. Please check policy wordings for more details.

**The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.

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