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Do’s and Don’ts for Filing a Health Insurance Claim

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An Overview

Health Insurance has become a necessity in uncertain times. Whether it’s a pandemic virus, critical surgeries, or underlying chronic diseases, it acts as a saviour and saves you from expensive medical expenses. That’s why we prioritise a smooth and hassle-free claim settlement when we encounter any medical emergency. But you should be wise enough to understand that your medi claim policy has strict guidelines and prerequisites for claim settlement. Hence, you should be aware of the Dos and Don’ts that you must do while filing your claim.

Filing a health insurance claim can be daunting, especially when you are dealing with staggering medical bills and mental trauma. However, with the right approach and guidance, you can streamline the process and ensure that you receive the coverage you deserve. In this guide, we will explore the essentials that you must follow for a smoother claim settlement. 

The DO’s

1. Understand Your Policy

Before you file the claim, read the policy and understand what it covers and what it doesn’t. Also, ensure that accurate and complete information is provided to the insurer. Errors or omissions can lead to unnecessary delays. Therefore, double-check all the details before submitting your claim.

2. Keep Detailed Records

It’s essential to keep records of medical bills, receipts, and medical reports and share them with the insurer whenever required. Recording your medical expenses and furnishing all the necessary hospital bills and receipts while filling out your claim is critical. This step will help you avoid last-minute hassles and prevent health insurance claim rejection. 

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3. Timely Intimation

Some insurance companies have strict timelines for submitting claims after hospitalisation or treatment. Make sure to submit the health insurance claim on time to avoid unnecessary rejections. 

4. Disclosure of Pre-existing Diseases

If you have any pre-medical condition you didn’t disclose when purchasing the insurance, make sure to disclose it while applying for a claim. Failure to disclose pre-existing diseases can directly lead to health insurance claim rejection.

5. Admit to Network Hospital

 Whenever possible, get admitted to a hospital within your insurance network. This ensures smoother health insurance claim processing and reduces the likelihood of coverage disputes.

6. Seek Help if Needed

We know the hassle associated with claim processing, but it can be reduced if you feel overwhelmed or unsure at any stage. For insurance claim denials and disputes, you can seek guidance from insurance professionals like Insurance Samadhan to ensure you receive fair and timely compensation.

The Don’ts

1. Don’t Assume Everything Is Covered: 

 Just because you have health insurance does not mean that every medical expense will be covered. There are various limitations, and your policy only offers coverage to an extent. Therefore, familiarise yourself with your policy coverage, limits, and pre-authorisation to avoid last-minute inconvenience. 

2. Remember to Pre-Authorize:

 Some health insurance plans require pre-authorised specific treatments or procedures. Please obtain pre-authorization to avoid denying your claim, so check with your insurer before undergoing any non-emergency medical services.

3. Don’t Throw Away Documentation: 

Don’t tear your medical bills, as it is essential to show your healthcare expenses during claim settlement.  Keep everything organised in a file or folder for easy access. Failure to show any records or medical receipts can lead to a lesser claim. 

4. Don’t Assume a Denial Is Final

Health claims are hard to crack; hence, don’t assume that your insurer’s rejection of your claim is the end of the road. As mentioned, many denials are overturned on appeal, so it’s worth pursuing if you believe the denial is unjustified.

Final Words 

Investing in health insurance is always better to protect you and your family from unexpected medical emergencies. By following these do’s and don’ts, you can easily avoid last-minute chaos and claim delays. However, for quick claim settlement, you can contact Insurance Samadhan for expert resolutions and speedy claim settlements.

Click here to register your complaint with Insurance Samadhan

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Mail us at corporate@insurancesamadhan.com

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