Best practices to raise Medical Insurance claim

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Raising medical insurance claims is sometimes a difficult process for those who haven’t followed some basic steps in the first place. Here are some best practices worth following while raising medical insurance claims:

  • Be mindful of sub-limits for claims: You should ideally purchase health insurance policies minus any sub-limits which can limit the amount to be claimed under particular medical treatment/hospitalization even in case the sum insured is large enough. Always fill up the proposal form on your own without any dependence on third parties or other intermediaries. At the proposal stage, total transparency is the best bet for enjoying a smooth claims procedure.
  • Disclosure of facts: While you purchased your policy, you must have disclosed all key facts since discrepancies in the future may lead to rejection of the claim. These facts include details of your income, ailments, occupation, consumption of liquor/tobacco and so on.
  • Sharing of proper information: While making a claim, make sure that you are sharing all accurate and total information about the hospitalization, expenditure incurred and other expenses on tests, treatment and doctor’s fees.
  • Read the policy document carefully: The importance of this point cannot be emphasized enough! Always read your policy carefully before filing your medical insurance claim. You may come across terms and conditions that you were not aware of. In such cases, seek clarification from the company or agent prior to filing your claim.
  • Know more about exclusions: While reading your policy, always make sure that you know about the exclusions contained in the same. These include any self-inflicted injuries, attempted suicide, intoxicant abuse, participation in air force/naval/military operations or rock climbing/aviation/diving/racing, breach of law and so on. Other exclusions are also there for most health insurance policies which you should definitely know more about.
  • Always file health insurance claims on time: You should always file your claim on time and contact your insurance company or authorized person at the earliest. You should always fill up cashless forms if required at the network hospital 7 days before hospitalization dates. In case of emergencies, inform the insurance company while admitting the patient. Reimbursement claims must be informed to the insurer within 30 days of the date of discharge.
  • Have your documents in place: You should have copies of receipts of payments, medical documents and reports, discharge documents, consultation reports, bills and so on. The originals should be submitted with your reimbursement claim.
  • Have medical proof in place: To avoid situations where the insurer feels that medical treatment was not necessary and rejects the claim, make sure that you have medical proof in place by way of research and opinions from doctors.
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Following these best practices will help you file health insurance claims with minimal possibilities of rejection.

Shailesh Kumar

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