What Is a Health Insurance Claim?

Updated: November 9, 2022
What Is a Health Insurance Claim
Category:

No doubt, health insurance is a lifesaver and extremely useful in paying the medical expenses of any illness or hospitalization period. 

Such health insurances cover an extensive list of elements, including medicines costs, hospital expenses, cost of surgeries, visits to doctors, etc. 

In this blog, we discussed what a health insurance claim is and how it works. So, you can make the best use of your health insurance plan! 

Why should I choose a Health Insurance Plan? 

Here is a brief list of the benefits of signing up for a health insurance plan. Protect yourself and your family while providing optimal healthcare facilities through a comprehensive family health cover. 

We have a long-term healthcare guide just to give you an overview of  along-term insurance.

Protects against lifestyle diseases

Nowadays, lifestyle diseases like diabetes, obesity, pulmonary issues, heart disease, etc., have become common due to sedentary lifestyles and high-stress levels. You will have to pay a significant amount for the treatment. Therefore, comprehensive health insurance safeguards you from big medical bills. 

Provides a shield during medical inflation 

The advancements in the healthcare sector have resulted in raised prices of new medicine, cost of tests, treatments, etc. However, a health insurance plan protects you from medical inflation and provides you with quality treatment and services at any cost! 

Helps secure your savings 

If you experience an unfortunate accident or encounter an illness, you will have to spend your hard-earned money. But health insurance helps you access quality treatment and medical facilities. 

What is a Health Insurance Claim? And how does it work? 

Simply, a health insurance claim is a request made by the healthcare provider to your insurance company once they have provided you with the medical procedure or service. A good health insurance claim is necessary because it ensures a stress-free payment process during a medical emergency. Therefore, you need to understand the working process of insurance claims to rely on your health insurance policy. 

One of the most important things is to ensure that the treatment you receive is under insurance coverage. Therefore, invest in a slightly expensive health insurance plan that covers an adequate amount of medical services and care. So, you don’t have to worry about not getting sufficient coverage. You may check here for the best health insurance companies and their review for your benefits. 

 

The two types of claims admitted by health insurance policies are:

1. Cashless claims 

Most importantly, cashless claims are convenient and hassle-free. Most insurance companies have a network of associated hospitals to choose from as an option for your treatment. 

Under a cashless claim, you don’t pay the hospital when accessing their services. Instead, your insurance company directly settles the bills. 

How to avail cashless claims? 

  1. Select an associated hospital from the list if you want a medical procedure that requires hospitalization.
  2. Notify your insurance company four days before the appointment and submit a pre-authorization form. It helps you avail the cashless claim facilities. 
  3. Submit the insurance-related form to the hospital and wait for TPA to send you a sanction letter stating the amount freed from your treatment. 
  4. However, in the case of an emergency, inform your insurance company within 24 hours of hospitalization to access the cashless claim facilities. 

2. Reimbursement claims 

Under the reimbursement claim option, you are to pay the bills yourself, and then when the claim is processed, your company will reimburse you for the hospital bills. It isn’t as convenient as the cashless claim, but you are free to choose a hospital of your liking under this option. 

How to avail reimbursement claims? 

1. Submit all the required documents. They include: 

  • Claim form 
  • Hospital discharge certificate 
  • Original bills 
  • First Information Report (FIR) if you were involved in an accident 
  • Your case file 
  • Cash memos for medicines 

2. After verifying the documents, the insurance company will reimburse you for the hospital expenses. 

Must-know things to keep in mind when raising a health insurance claim 

Undoubtedly, medical emergencies are hectic, but whatever the case is, you should keep the following things in your mind: 

  • Keep the required documents in check 
  • Healthcare insurance claims have a claim limit chosen by you. So, make sure to select a policy with adequate coverage. 
  • Keep the exemptions in mind because you will not receive coverage for them 
  • In the case of cashless claims, keep a list of partner hospitals ready for any emergency
  • Make sure to renew your health insurance policy timely 

Check on and get an affordable health insurance quote. Here you can also know about the health insurance in Washington DC.

Get A Free Affordable Health Insurance Quote