Here's how you can ensure reimbursement insurance claims are settled in time

Why do you buy health insurance? The very reason to have it is one may not be able to afford medical expenses. This is why a policy with a cashless claims settlement facility is advised more. However, this service is only offered among network hospitals that the insurance company has. In cases where the hospital doesn’t offer cashless, you may have to pay through your pockets. Are reimbursement claims difficult to be settled? We received a similar query on Money9 Helpline:

I have a health insurance policy from an insurer which I bought from an agent of a private bank. The health cover is Rs 3 lakh and bonus cover is for Rs 1.5 lakh. I recently got diagnosed with appendicitis and I have to undergo surgery. I want to use my health insurance in this case but I don’t have any prior experience about how to claim or what to do. The hospital where I have to undergo the operation does not offer cashless service. What to do in that case? How do I ensure that my claim is settled hassle-free?

– Nandita Awasthi

Expert view

We approached Rakesh Goyal, Director, Probus Insurance, to address the query:

One need not worry if some of the hospital doesn’t allow cashless service. You can file for the reimbursement claims after initially paying the cost of the treatments. When you file a claim, you must produce the bills and showcase other records of the money spent on hospitalisation and treatment. The insurance company, after verifying the bills, will credit the amount to your bank account. Nowadays even all these claims are hassle-free if documents are in place.

However, it is important to note that an individual needs to start the reimbursement process within seven days of the patient’s discharge. You should get in touch with the insurance company from where you have bought the policy and give the bills, prescriptions, discharge summary and other necessary documents when you request for reimbursement. You have to fill the form and submit all the documents to the insurance company.

The insurance company would, then, analyse the claim, the related documents and the expenses incurred. Later the expenses would then be reimbursed. Typically, the general turnaround time for the process is 20-30 days from the date of receipt of all documents.

One needs to verify the documents and see that no document issued during the treatment process is missing as this is necessary to avoid a claim shortfall. Remember, that health insurance companies will not honour claims in case the documents are not as per their terms and conditions.

Policyholders should also remember that there is something called exclusions in insurance policies. It is likely that the entire medical expenses incurred during hospitalization may not be reimbursed to the health insurance policyholder. If a claim is made for an excluded expense, the claim would be rejected. So, the plan exclusions should be checked before making a claim so that a claim for an excluded expense is not made.