What is the Process for Claiming Emergency Services?

During a medical emergency, the policyholder or their family can file for a cashless or reimbursement claim.

While cashless claims are only available at the insurer's network hospitals, the reimbursement process is applicable at any hospital. However, for reimbursement claims, policyholders have to settle their bills out-of-pocket.

Continue reading to discover the steps to file for a cashless or reimbursement claim during a medical emergency.

What are the Steps to Receive Cashless Claim During Emergency?

Step 1: Inform Your Insurance Provider

To ensure a smooth claim, notify your insurance company or third-party administrator (TPA) within 24 hours of hospitalisation. Either write the insurer an email or call the customer care assistance on their toll-free number.

Step 2: Provide Necessary Documents

To verify your eligibility for cashless claims, visit the insurance desk at the hospital with your health ID card.

Step 3: Submit Pre-Authorisation Form

Fill out a pre-authorisation form carefully to provide your insurer the details of treatment and estimated expenses. Afterwards, the hospital will send this form to your insurer for approval.

Step 4: Claim Processing

After receiving the pre-authorisation form, the insurer will verify the documents to process your cashless claim.

Step 5: Claim Settlement

Once the treatment is completed, the hospital will share the bills with the insurer. Thereafter, they will pay the claim amount directly to the hospital, reducing your out-of-pocket expenses.

What are the Steps for Reimbursement Claim Process for Emergency Services?

Step 1: Contact Your Insurer

Like cashless claims to initiate a reimbursement claim, the patient's family must contact the insurer or their third-party administrator (TPA) within 24 hours of hospitalisation.

Step 2: Pay All Hospital Bills

Once seeking proper treatment during medical emergencies, the policyholder has to pay all hospital and medical bills from their own pocket upon discharge. Moreover, they should collect all the medical documents, bills and payment receipts as proof of a medical emergency.

Step 4: Fill Out the Claim Form

You can easily fill out a claim form online through your insurer's official website. Or else, you can submit the form at your insurer's nearest branch office. In both of these cases, it is essential to provide accurate policy details, personal information, and hospitalisation details in the claim form.

Step 5: Claim Initiation

After verifying the documents, your insurance will reimburse the cost of all medical expenses incurred during the hospitalisation.

Things to Avoid During a Health Insurance Claim

• Do not submit incomplete or incorrect documents during the claiming process.

• Try not to make claims for medical services which are not included in your policy.

• Do not submit a claim for a hospital stay of less than 24 hours.

• Never provide false information or hide medical history to prevent claim denial.

Final Words

A clear understanding of the claim process will reduce your stress and ensure faster financial support during medical emergencies.

However, to avoid any hassle of upfront payment, try to find a network hospital in such situations. This way, you can fully focus on recovery while your insurance handles your medical expenses.