Intimate your insurer within 24 hours of hospitalisation

BEING familiar with procedure of filing a health insurance claim can save you and your family members from hassles when you need to make one, especially in case of an emergency. While one cannot do much in case of non-planned emergencies, one can certainly reduce efforts and hassles by following proper procedures.

Unplanned medical emergencies: In a road accident or a medical emergency at home, it may be difficult to get admitted in the preferred provider network (PPN) of hospitals as mandated by your insurer. The priority would be to get admitted in the nearest possible hospital.

In such cases too, it is advisable to intimate the insurer about the incident within 24 hours of hospitalisation. If the hospital is not a part of the PPN, then cashless treatment cannot be availed, and the insured has to settle the medical bills and get it reimbursed by the insurer.

It is always advisable to carry your health insurance policy number and photo identity card or medical identification card with you, so that it can be presented at the time of any medical emergency.

Cashless claims: To do so, the hospital should be empanelled with your insurer.

In order to admit the patient and treat him, hospitals a ask patient's attendant to deposit some money. The attendant should inform the hospital representative about the health insurance policy so that they can intimate the insurance company and register the claim.

While informing the insurance company, insurance company representatives ask for the treating doctor's name, doctor's preliminary report, hospital's name and nature of ailment.

As soon as the intimation is given to insurer, as an industry practice, the claim approval is provided within one to four hours. Also, insurers check with their underwriting team for any preexisting disease. If the claim is related to any pre-existing disease, the hospital and policyholder is informed accordingly.

If the claim approval is not received before the commencement of treatment, patient's attendant should pay the necessary money that can be claimed later on from insurance company.
Claim reimbursement: In case the hospital where the policyholder has being treated is not empanelled, he needs to register a claim after he is discharged from hospital. Once the policyholder is discharged after settling all his medical bills, he should collect all original medical documents and bills to file a claim with his insurance company.

In many emergency medical cases, the patient is admitted in intensive care unit (ICU) as well. The hospitalisation charges goes up in these cases. Although, the health insurance policy covers such charges, it should be kept in mind that the sum insured is adequate to cover those charges.

Depending upon the room chosen by policyholder, charges such as consultant's fees, operation theatre charges and medical equipment charges vary.

Most health insurers also cover ambulance charges.

Generally, insurance companies cover around Rs 750Rs 1,500 for emergency ambulance charges that may claimed once or twice in a policy year.