Understanding 5 Essential Aspects of Reimbursement Claims in Mediclaim

Cashless claim settlement is the most preferred and convenient method of claim settlement, as you receive medical treatment without upfront payment. But often, many people still opt for reimbursement claims.

With reputed health insurance providers like Tata AIG you can easily compare health insurance and make the best purchase decision as per your requirement and budget. Moreover, they also offer straightforward, reliable, and hassle-free claim settlement processes.

However, people may need clarification on filing reimbursement claims. Therefore, to ensure a quick and easy reimbursement process, let’s understand 5 essential aspects of medical claim reimbursement in a health insurance plan.

 5 Important Aspects of Reimbursement Claim in Mediclaim

1. Type of Medical Insurance Plan

When you file for reimbursement for online health insurance, you must know the main two types of medical insurance plans.

Indemnity Health Insurance

In this health insurance plan, your hospitalisation expenses up to a specific limit are covered. If the bill goes beyond that particular amount, you have to pay from your pocket.

Defined Benefit cover

In this health insurance plan, you are covered for specific medical conditions or illnesses. Further, you receive a specific amount, which is fixed regardless of your actual expenses.

Therefore, these two terms are essential for filing your reimbursement claim. Also, health insurance claims are term and condition-based, so read them carefully before filing your reimbursement claim. Hence, understand the coverage details outlined in your policy.

2. Documents Needed to File Reimbursement

Proper documentation is essential to get the reimbursement claim. Ensure all the medical bills and related documents are complete, accurate and legit to avoid any delay or rejection of the claim. Some of the common documents required for reimbursement claims include:

1. Your filed medical insurance claim form
2. Copy of healthcare and medical insurance policy
3. All investigation reports like X-rays, blood tests, any critical and related scans with regards to your medical condition and reports, etc.
4. Copy of prescriptions and consultation of doctor
5. Ordinary copy of discharge summary
6. Original copy of medical bills
7. Receipts of all bill payments made
8. In case of an accident, a copy of the FIR file or medico-legal certificate
9. Copy of KYC documents
10. Your Bank credentials

3. Timeline for Filing Medical Reimbursement Claim

There is a specific timeline to file a reimbursement claim for a health insurance policy. Therefore, it is essential to know about the same:

• The timeframe of the health insurance policy may vary from 15 days to 90 days once you are discharged from the hospital.
• Submission of all the documents (mentioned above) is essential, as delay can lead to claim rejection.

It is best to file the claim as soon as you are discharged. Just keep in mind that claims are subject to terms mentioned in your policy.

4. Appeal Process

If your claim gets rejected or you are availed with only partial claim, it is important to be aware of the reason for rejection or partial reimbursement. Hence, you must know the appeal process provided by your insurer.

5. Maintain Two Way Communication

Understand each insurance claim is unique, and due to complications, your settlement may take longer.

Therefore, maintain effective and open communication. You can reach out rather than wait for the insurance company to email you. Just maintain honesty and cooperate throughout the claim settlement process. This approach helps ensure a smoother resolution for both parties involved.

 Other Important Aspects To Remember of Reimbursement Claim

1. Keep a complete understanding of your health insurance policy, i.e., coverage exclusion limitation.
2. Notify your insurance provider why you intend to file for a claim. Ensure you follow all timelines and inform your provider immediately.
3. In case of a medical emergency, provide all the details of medical circumstances and help received.
4. Maintain a date-wise record of medical expenses with all supporting documents such as prescriptions, doctor consultations, reports, etc.
5. Double-check and provide complete and correct information on your claim form.
6. Be patient and understanding with regard to the waiting period, and don’t put unnecessary pressure on your insurance provider.
7. Always ask when you have any doubts or need clarity about certain aspects of the claim.
8. If your claim is denied, then you can appeal again. Just follow your provider’s appeals process carefully. You can also provide more info if you have more documents to support your claim during the appeal.
9. Seek professional help from an advocate or legal counsel if you face any challenges while filing your claim.

 Conclusion

Though you might feel overwhelmed when filing your claim for medical reimbursement, it is important to keep in check all the aspects mentioned above. Further, keep your health policy up to date and stay healthy to protect yourself financially.