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How to Make Health Insurance Claims During Medical Emergencies?

Team AckoJan 17, 2024

You buy a health insurance plan in hopes of getting your medical expenses covered when the need arises. Thankfully, the claim process is pretty simple and if you have the right documents in place, you can get it processed quite smoothly. Take a look at this article to know how you can make a medical insurance claim and be prepared to do so in the case of an emergency.




Making a Cashless Health Insurance Claim

As we all know, there are two types of health insurance claims – cashless and reimbursement. Let us first understand the procedures involved in a cashless claim:

Inform the hospital

Inform the billing desk about the cashless mediclaim insurance policy that you have. If you have a planned hospitalization, it would help you to inform them even before the admission takes place. But since that won’t happen in an emergency, a relative or friend should inform the hospital on your behalf, if you are admitted. If you accompany a family member who is also covered in the plan, do the job yourself.

Third Party Administrator card

You will be given a TPA card when you buy the cashless medical insurance cover. Present this card to the hospital billing desk or the TPA counter as soon as you locate it. It is always advisable for you to keep the card with you. So, if you get involved in an accident or need medical attention due to some other emergency, the card will be with either you or a friend can present it to the hospital.

Inform the insurer

You must inform the insurance provider about your hospitalization at the earliest. They will coordinate with the hospital and the TPA and arrange for the cashless claim to be paid out.

Know the network hospitals

It is always a good idea for you to be in the know about the network hospitals. This is important as cashless mediclaim insurance claims can only be availed in a network hospital. If you need to get admitted in an emergency, try your best to go to a network hospital.

Making a Reimbursement Health Insurance Claim

The reimbursement claim works in this way:

  • You get admitted to any hospital, whether it is a network hospital or not.

  • You get admitted and get treated if there is a medical emergency.

  • You pay the bill yourself and get discharged.

  • You send the bill and the needed documents to your insurance provider who then reimburses the amount, after adjusting the deductible. If there is a critical illness insurance cover associated with your plan, you can make a claim for that too in a similar fashion.

Also, read: 8 Tips to Save Hospitalization Bills with Health Insurance Policy

Documents needed for Health Insurance Claims

You need the following documents for a medical insurance claim:

  • Duly filled claim settlement form

  • Medical certificates, attested by the consulting doctors

  • Summary of the discharge

  • Copies of doctors’ prescriptions

  • Original pharmacy bills

  • Original bills of the hospital and pharmacy

  • FIR copy, if any

  • Legal documents (in case of accidents)

Keep all the documents ready when you file your claim. This will smoothen and hasten the process and you will get your health insurance claim easily.

In conclusion

To ensure you get your claim, you first have to be honest and discreet when you apply for your health insurance plan. Never lie on your claim form and be open about your pre-existing illnesses, past health records, etc. If needed, opt for a critical illness insurance cover and stay protected in a comprehensive manner. Submit the correct documents and your claim will surely be processed without too many issues whatsoever.

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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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