Top 6 Things You Need, When Filing for Reimbursement Health Insurance Claim

Did you know about these 6 essential things related to reimbursement claim of your health policy? Here take a look so that you don’t miss out anything.
Top 6 Things You Need, When Filing for Reimbursement Health Insurance Claim (1)
The hospitalisation of loved ones has a profound impact on any of us. The worry about medical expenses which adds up to the tension. With the ever-increasing healthcare costs, having a health insurance is now a necessity. If you already have health insurance, you must save yourself from treatment expenses.
There are two simple ways for these expenses: cashless claims or reimbursements. Cashless is the simpler of the two. Any insurance company’s network hospitals allow you to avail the mode. But, cashless claims is possible during planned hospitalisations. In case of an emergency, you may have to opt for reimbursement option.
There are 3 different categories under which you can claim your expenses which are hospitalisation, pre- and post-hospitalization. Each phase needs a different set of documentations for reimbursements.

Pre-hospitalisation

If you are facing any health concerns, the first step is a physician consultation. The doctor would carry out the initial investigation. The medical expenses you incur during this preliminary investigations fall under the pre-hospitalisation. The following are some relevant documents required.

  1. A duly filled form for a reimbursement claim
  2. Investigation reports before hospitalisation
  3. Prescription for medicines and any pharmacy bills – before hospitalisation
  4. Bill or receipt for cash payment for consultation
  5. Letter of reference to the hospital post the investigation
  6. Any bills for investigations done before admission to the hospital

Hospitalisation

Any expense the insured undergoes during their inpatient admission falls under hospitalisation charges. It could vary from surgeries to regular hospitalisation for a few days. You need these 6 essential things before claiming a reimbursement.

  1. A duly-filled claim form
  2. Your insurance card along with any other ID and address proof
  3. Discharge summary in details or death summary should the worst happen
  4. Original bill provided by the hospital along with complete break-ups
  5. Prescriptions for medicines and bills from the pharmacy for medicines and tests during hospitalisation
  6. Doctor’s advice for admission

Post-hospitalisation

There are several instances where your treatment doesn’t end with a discharge from the hospital. Some common activities include any follow-ups required, added medications, investigations needed for more clarity, etc. Money spent for such scenarios come under post-hospitalisation expenses. The main documents needed for this phase are as follows:

  1. The reimbursement claim forms along with an ID proof
  2. Medicine, prescriptions and any pharmacy bills – post discharge
  3. Investigation reports if any – post discharge
  4. Doctor’s prescription for medicines and investigations post-discharge for health improvement
  5. Documentation for National Electronic Fund Transfer (NEFT) like cancelled cheque, etc.
  6. Any cash bills available for the investigations completed

Without these main documents, you cannot file a reimbursement health claim.

Rejection of health insurance reimbursement claims is a common fear. There could be several reasons for this. But, the most common ones are insufficient clarity provided by the policyholder. There is also another factor—misunderstanding of the policy. Thus, obtaining clarity up front on any health-related issues is a necessity. Be thorough with your policy documentations.
Once you reach out to your insurance company for medical claims, they will help you with the process. They will also provide you with a list of required documents. Make sure to provide all the documents in the list. Always keep a copy of them with you. The reimbursement process might take a few days. You can follow up in the meanwhile.

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