Make Health Insurance Claims a Smoother Process

With the improvement of financial services in the country, financial instruments have spread well among the population. Investors are now well versed with different schemes. They are capable of comparing Mutual funds in India. They get financial advisors to guide them on the best tax saving Mutual Fund.

But one essential product where India lags behind is health insurance. According to the recent revelations by the National Sample Survey (NSS), over 80% of the people were not covered under health insurance. One of the complications associated with health insurance is the claims process. They get delayed, or rejected altogether. Reasons range from administrative delays by the hospital, to poor documentation, or even poor understanding of the scheme by the policyholder. It is imperative to have proper knowledge of the health insurance policy and the process involved for claims. The three steps given below will help you to actively deal with the process.

Know the policy

Before you zero in on the policy, make sure to go through all its features. Choosing the right policy for you is important. Also make sure that your neighborhood hospitals are in the insurer's network. Since they have a clear arrangement and an understanding of the medical procedures, claims are settled faster. In the case of hospitals which are not in their network, hospitalizations are through reimbursement, which can be a long process.

Go through the exclusions

Before you buy the health insurance, enquire what all is excluded from the cover. Also look at the waiting period of the policy, which refers to the initial time period when you cannot make the claim. There are three kinds of waiting periods. It is typically for 1 to 3 months. There is also a disease specific waiting period of 1 to 2 years, such as for cataract. Lastly, the period for a pre-existing ailment can be at least 4 years.

Other than exclusions, also check if there is a sub-limit clause. Sub-limits cap the liability of the insurer.

Know the procedure

Once you have gone through the important features of the policy, look at the claims settlement process. In case of a planned hospitalization, the claims process is initiated before the admission. For cashless claims, your doctor and you fill up a pre-authorization form. Once you fill your personal and policy details, the form is sent to the doctor to fill details regarding the ailment and treatment. The bill is then sent to the billing department to fill the estimate as per the treatment. Then it is signed by the treating doctor and the patient, and sent to the insurer. Since you cannot authorize in case of an unplanned hospitalization, you are asked for a deposit which can be reimbursed later. The whole process can take from a couple of hours to a day.

A proactive approach is required to manage the situation and get the policy to pay for the expenses. Prior knowledge of the intricate details of the policy will help you deal with unplanned hospitalization.