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Step-by-Step Procedure for Filing a Health Insurance Claim

Team AckoJan 17, 2024

Making a claim against your health insurance policy correctly, is as important as buying the best suitable plan for yourself. A claim can get rejected due to a simple and avoidable mistakes.

In this article, we will discuss the proper steps that you need to take while filing your health insurance claim. This will ensure a smooth claim process and help in avoiding claim rejection.




Types of Health Insurance Claims

Usually, one can file a claim via any of the following ways:

  • Cashless health insurance: As the name suggests, you do not have to pay the entire hospital bill while filing a claim against cashless health insurance. You do not have to keep track of the bills and other invoices for submissions when you avail a cashless mediclaim. You just need to keep the Cashless Health Card ready. Remember that a cashless mediclaim can only be filed in a network hospital. A network hospital is the one with which your health insurance company has a tie-up. In this manner, your insurer will be able to directly settle the bills with the hospital. A cashless claim is not 100% cashless, you have to simply pay a negligible amount against deductibles.

  • Reimbursement Claims: You can choose to avail treatment in any hospital of your choice or as per convenience. It need not be a network hospital. In this type of claim, you first have to bear the entire cost related to the treatment, collect necessary invoices and other documents and then file for a reimbursement claim. Once your claim is approved, your health insurance company will pay the claim amount after subtracting the deductible.

Step-by-Step Procedure for Filing a Cashless health insurance claims

Step 1 Coverage

Know about the exclusions and inclusions of a policy. This will be helpful at the time of availing treatment in a hospital and in avoiding claim rejection. Second thing is to check the names of the network hospital. To be able to avail treatments against cashless mediclaim policy you need to go to a network hospital only in case of a medical emergency. Thus, choose a health insurance company that has a tie-up with a larger number of hospitals.

Step 2 Get in touch with your insurer

In a cashless claim, you do not have to keep a record of the bills however you need to get in touch with the Third Party Administration (TPA) or your insurance company. He/she will help you to fill a Pre-Authorization Form. This will help in claim approval for your cashless mediclaim policy. You will also be asked to show your Cashless Health Card and identification details at this stage.

Step-by-Step Procedure for Filing a Reimbursement Claim

Reimbursement claim is like a back-up for cashless claims. If you do not avail treatment in a network hospital you will have to settle the bill amount with the hospital and then file a claim.

Step 1 Intimate

Even if you would file for a reimbursement claim later, you need to intimate your health insurance company when you begin availing treatment at the hospital of your choice.

Step 2 Application

You need to collect the claim form, either from your insurance agent or download it from the website of your insurer if this facility is available. Fill the form and attach the required documents, for example: bills, discharge summary, etc.

Step 3 Post Hospitalization

Your insurer may also ask for a fitness certificate after hospitalization. In case of any post-hospitalization treatment, submit those bills as well. Your claim shall be processed within a few weeks and you will receive the maximum claim amount.

As mentioned earlier, make sure to read the health insurance policy at the time of purchase. Try to understand all the important aspects of the policy documents, these could include the terms and conditions or the inclusions and exclusions. This will help you prevent any hiccups in the claim process.

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Disclaimer: 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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