What Is the Process of Health Insurance Claim Settlement?

During any medical emergency, the first thing you look for is a hassle-free claim settlement. But, do you know your one wrong step while filing a claim can create chaos. That is why it is necessary to acquaint yourself with the proper process of health insurance claim settlement. However, every health insurance company has its procedures and documentation for the claim. You should check those terms and conditions before buying a health policy. Here are some common steps that help you to understand how claim settlement works in health insurance: 

Types of Claim Settlement

Under any health policy, you can claim in two ways:

  • Cashless Claim Settlement
  • Reimbursement Claim Settlement

Cashless Claim Settlement

In cashless health insurance claim settlement, the health insurance company itself settles your medical bill with the hospital. Admission in any network hospitals impaneled with the company is mandatory to get a cashless hospitalization facility. You can check Care insurance plans details; they have a good number of cashless healthcare providers. This facility eliminates the stress of arranging the cash for the treatment. Whether an emergency or planned hospitalization, you can go for cashless claim settlement stress-free. 

The process for cashless claim settlement is as follows:

  • Get the pre-authorization form available at the hospital’s insurance / TPA Desk
  • Send it to the customer support team
  • You will get an approval letter after verification
  • For any further query from the claim management team, you or the hospital staff must respond to it.
  • You can carry on your treatment as per the doctor’s advice and file for a reimbursement claim a cashless request gets rejected.

Reimbursement Claim Settlement

In reimbursement claim settlement, the company will reimburse (refund) your medical bills after a specific duration. It is applicable for non-impaneled hospitals. Suppose you get admitted to any non-impaneled hospital; you need to pay your hospital bills while discharging from the hospital. 

The process for reimbursement is as follows:

  • Submit a claim form along with required documents, as per the policy terms & conditions
  • You will receive an approval letter sent by the claim management team
  • Insured to respond to the query raised by the claim management team
  • The team will communicate the reason in case of rejection

Top Health Insurance Companies Offer Health Insurance  

Below is the list of some leading health insurance companies in India that offer hassle-free claim settlement: 

Health Insurance CompanyNetwork HospitalsClaim Settlement Ratio (CSR)
IFFCO Tokio4000+92.66%
Care Health Insurance8350+95.2%
HDFC Ergo10000+90.32%
Max Bupa Health Insurance4500+83.92%
Star Health8800+78. 15%

You can check the plans from Care Health Insurance or IFFCO Tokio; they have good CSRs, and their claim settlement process is simple and easy. Do not forget to read the terms and conditions before selecting the best health insurance policy.

Points to be remembered

While filing a claim, either cashless or reimbursement, there are few things that you must remember:

  • Intimation to the customer support team is necessary within 24 hours of emergency hospitalization and 48 hours before planned hospitalization.
  • Cashless claim facility is allowed only in the network hospitals listed with the health insurance company.
  • Check the network hospitals on the company’s official website while entering your area pin code.
  • For non-network hospitals, you can go for reimbursement claim settlement 
  • Keep the original copies of the doctor’s prescription, diagnosis, discharge summary, pharmacy bills, etc. 

Takeaway

Health insurance claim settlement is easy if you have the best health insurance policy from a trusted health insurance partner. So, look at all the factors, including the claim settlement process, to make a wise decision.