Insurance is a potent tool that can give you financial protection against unwarranted situations. Based on the type and extent of health insurance policy you can prepare against financial liabilities arising out of medical emergencies, covered diseases, and planned hospitalization. In the current times, healthcare costs are rising at lightning speed and so are instances of critical illnesses and lifestyle diseases. In such a situation, you would feel more in control of your financial coverage to meet medical costs. However, a health insurance policy would only prove useful if it offers you extensive coverage, has limited exclusions, and comes with a simple claim process.
Now here a lot depends on the smoothness of the claim process and requisites to initiate the process as they will impact how quickly you are able to access the sum insured to meet medical bills. Hence, it is always recommended that you know what the insurance scope is, you pay attention to the claim process, terms and conditions of claim settlement, and prerequisites to streamline the process in the face of an emergency. However, only knowing what the insurance claim process is not enough to plan and streamline the process. You must learn more about the do’s and don’ts of raising claims to ensure timely access to the sum insured and minimize the risk of rejection.
Knowing the do’s and don’ts of filing health claim is important
You may find the process of filing a health insurance claim to be quite daunting, especially when you find yourself or a loved one struggling with illness and piling medical bills.
However, knowing what is insurance claim process is and its correct approach can make the process easy and swift. Such an approach will help you initiate the process swiftly and allow you to access the sum insured without any unwarranted delays or rejections. Here’s the do’s of a claim process that you can follow –
- Understand Your Policy
You must read the insurance policy document and understand the situations that are covered under it and what doesn’t help come under its preview. This is a must before you file an insurance claim.
- Share Correct Information
It is recommended that you share accurate and complete information when you fill out your claim form. Additionally, it is important to ensure the information is uniform and the same as the one previously shared by you when applying for the insurance. Any omissions, errors, or discrepancies, can cause delays in the verification process and claim settlement. So, make sure to double- check information before you submit your claim form.
- Keep All Records
Make sure to keep records of all your medical bills, prescriptions, receipts, diagnostics, reports, etc. These records will support your claim and provide insurers with the foundation to start their verification process. It is important to record all medical expenses, i.e., pre and post-hospitalization charges and aftercare, and furnish the same to the insurance company to avoid last-minute goof-ups or hassles.
- Timely Intimation
This is a very crucial stage that can decide the fate of your insurance claim. Make sure to inform your insurance company within the suggested window to avoid rejections. Insurance companies follow strict timelines for claim submissions. So, it is recommended that you ask your insurance agent or insurance company directly about the claim intimation window and the process thereon.
- Disclosure of Pre-existing Diseases
In case you have a medical condition it would be better if you convey the same to your insurance company. When you withhold information that can potentially impact your coverage and premiums, you increase the risk of claim rejection, especially when the insurer spots the discrepancy during the claim verification process. This is especially crucial in health insurance plans as they often come with a waiting period for pre-existing diseases.
- Seek Treatment in Network Hospital
While the IRDAI is trying to make insurance cashless treatment benefits applicable across all hospitals beyond network hospitals, the process is yet to be streamlined. So it is recommended that you either pick renowned healthcare facilities that have accepted the norm or seek treatment under a hospital that comes under its network. This will ensure you have a smooth claim process and reduce the chances of disputes.
- Seek Help, if Needed
If the claim filing process seems overwhelming or you are unsure of how to proceed, you can always seek assistance from a professional. In such cases, the best bet would be your insurance agent. You may also choose to contact the insurance company or visit the nearest branch for assistance. However, if you feel your claim has been rejected on unfair grounds or the insurer fails to provide any reasonable answer you can contact grievance redressal platforms or seek assistance from higher authorities. Nowadays, you can find Third-party insurtechs are helping insurance policyholders to settle claims with their insurer. If required you can avail their assistance to settle disputes and receive timely compensation.
Now that you know the do’s of insurance claims let’s check the don’ts of the filling process –
- Don’t Assume that Everything will be Covered
Having health insurance does not guarantee that all your medical expenses will be covered under it. Each insurance plan comes with some limitations and covers specific instances. It is your responsibility to check the extent of coverage when purchasing a policy to understand what is included and what is excluded. This knowledge will help you avoid last-minute confusion and enable you to build provisions against situations that are not covered under your preferred plan.
- Make sure to Pre-Authorize
When you browse health insurance plans for family, you will find that some policies need policyholders to get pre-authorization for specific processes or treatments. Skipping this step could increase the risk of getting your claim rejected. Hence, make sure to check with your choice of insurance provider the pre-authorization requirement and make it a point to inform your insurer before undergoing surgery or treatment.
- Don’t Get Rid of Documents
Documentation is crucial for claim approvals. In case you fail to submit the complete set of required bills and reports, you may end up getting a lesser claim amount or face rejection altogether. So be mindful of your bills and make sure you do not tear or misplace them before your claim is settled. It is always a good idea to organize your documents and keep them in a separate file for easy access.
By keeping these dos and don’ts, and what insurance claim requisites in mind you can eliminate last-minute chaos. It will also help you streamline the claim process.
