Health insurance protects yourself and your loved ones from unforeseen medical bills. Even with the finest insurance coverage, the claim process may be complicated. Submitting a claim with your health insurance provider may appear complex, but it does not have to be. You can ensure a smooth and trouble-free claims procedure by understanding the stages involved and having the necessary information. 

Filing a health insurance claim can help cover your medical expenses and provide financial assistance during difficult times. However, you should compare health insurance policy and find the best-suited coverage for your needs and budget. 

This article will walk you through filing a claim with a private health insurance plan, making it easier to obtain the medical care you need without worrying about the financial burden.

What are the types of Claims?

A private health insurance plan allows you to make two sorts of claims: cashless claims and reimbursement claims.  

Cashless claims

Cashless claims are a simple option for receiving medical care without paying for it in advance. You can make this claim when you obtain care at a network hospital or medical institution. The insurance immediately settled the payment with the hospital under this approach, and you need to pay the deductible or copayment, if any.

Reimbursement Claims

When you pay for medical care out of pocket and then seek reimbursement from your insurance, you file a reimbursement claim. You can make this claim when you obtain care at a non-network hospital or medical institution. You must pay for the therapy in advance and then submit the bills and supporting documentation to your insurance for reimbursement.

Step-by-Step Procedure for Getting Cashless Healthcare Insurance Claims

Filing a cashless health insurance claim is a handy alternative when you receive medical care at a network hospital or medical facility. The following stages are involved in filing a cashless claim:

1. Choose a network hospital or medical facility

To receive cashless care select a hospital or medical institution part of your insurer’s network to receive cashless care. You may get a list of network hospitals on your insurer’s website or by calling customer service.

2. Display your health insurance card

When you visit a hospital or medical institution, you must display your life health insurance card and offer other pertinent information to hospital workers, such as your policy number.

3. Submit a pre-authorisation request

The hospital staff will contact your insurance to begin a pre-authorisation request. You must disclose all pertinent medical information to the hospital personnel, including the nature of the disease or injury, the suggested therapy, and the projected cost of treatment. If the request fulfils the policy terms and conditions, the insurer will evaluate it and authorise the cashless claim.

4. Get treatment

If your cashless claim is granted, you can receive treatment without paying it in advance. The insurance will settle the payment directly with the hospital, and you will only be responsible for the deductible or copayment, if applicable.

5. Follow up on the claim

Following treatment, the hospital will supply pertinent papers, including invoices and discharge summaries. Thoroughly study these documents to ensure that all of the facts are right. Contact your insurer’s customer service with any problems or queries.

Step-by-Step Procedure for Filing a Reimbursement Claim

Submitting a reimbursement claim is receiving repayment for previously incurred medical expenditures. You can choose if you obtain medical treatment at a non-network hospital or medical institution. The following stages are involved in submitting a reimbursement claim:

1. Pay for treatment

You must pay for medical care in advance at a non-network hospital or medical institution. Maintain all pertinent bills and receipts as proof of payment.

2. Gather all relevant paperwork

Following treatment, you must collect all necessary documents from the hospital or medical institution, including bills, receipts, and medical reports.

3. Fill out the claim form

Get the claim form from your health insurance provider. Fill out the form completely and accurately, including your personal information, insurance number, and data on your medical treatment and costs.

4. Send the following papers and claim form

Send the completed claim form and all needed documents, such as invoices, receipts, and medical reports, to your insurer’s office, through email or an online portal.

5. Wait for claim approval

Your insurer will check the claim form and documentation and assess the claim by the terms and conditions of your policy. If necessary, the insurer may request more information or documentation. The insurer will notify you after the claim has been granted.

6. Get reimbursement

According to the policy terms and conditions, the insurer will reimburse you for the allowed amount of medical expenditures. The refund will be deposited in your bank account or mailed as a cheque.

While making an insurance claim might be frightening, understanding the procedure can help you easily manage it. Whether you are completing a cashless or reimbursement claim, retaining all required paperwork and information is critical to guarantee a seamless and trouble-free claims procedure. Moreover, the cashless and reimbursement claim depends on the policy you have. So, you must compare health insurance policy to choose the ones that fit your needs.

Choose Niva Bupa if you’re looking for a dependable health insurance company. Through comprehensive private health insurance policies, Niva Bupa covers various medical expenditures, including hospitalisation, diagnostic tests, and procedures. Visit their website or call their customer service staff now to learn more about their health insurance policies and to receive a quotation.


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