A health insurance claim is a request that a health insurance policyholder submits to the Insurance Company to obtain the services covered in their health insurance policy. A health insurance policyholder can either get reimbursed or can opt for a direct claim settlement option (also known as cashless treatment) for the availed medical services. In this way, one can either submit the claim form or request the health insurance provider cashless services.
Providing healthcare service when needed is the actual utility of a health insurance plan. To ensure timely and easy settlement of all the medical expenses, one needs to initiate the health insurance claim process. There are two ways to claim a health insurance policy:
In this type of health insurance claim, the insurer settles all the hospitalization bills with the hospital directly. However, an insured needs to be hospitalized only at a network hospital to reap the benefit of cashless hospitalization. Once an insurer receives intimation from the attendant of the policyholder, the hospital (network) contacts them. The insurer verifies the validity of the policy and policy coverage of that policyholder. Then, a field doctor is assigned to facilitate the request for the pre-authorization document and cross-check the claimed treatment. After verification, a medical team from the insurance company approves the cashless claim for the policyholder as per the terms and conditions of the policy.
The general procedure to avail cashless claim for a health insurance policy is:
In this type of claim process, the policyholder pays for the hospitalization expenses upfront and requests reimbursement by the insurance provider later. One can get reimbursement facilities at both network and non-network hospitals in this case.
The general procedure to avail reimbursement claims for a health insurance policy is:
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