In the increasing uncertainty of the present world, to have a health insurance is a crucial aspect of financial planning. The need for health insurance is becoming increasingly popular worldwide with the widespread increase of viruses worldwide such as Psittacosis , Nipah Virus , Corona Virus etc.
It provides safety and security against unforeseen hefty medical expenses. It ensures that individuals can access best quality healthcare without worrying about the financial burden. But to properly understand how to go through the health insurance claim process can be daunting and confusing for many individuals.
In this comprehensive guide, we will see the steps to apply for a health insurance claim, common mistakes to avoid, and tips for a smoother process.
For instance, the data by Statistica suggests that about 514 million individuals in India are covered by health insurance schemes, the majority of which are sponsored by the government, while individual health insurance plans constitute a very small portion of the population.
With the health insurance penetration rate in India being around 35 percent, it becomes crucial for people to know the basic and simple steps for health insurance claim and reaping its benefits for years.
Understanding Health Insurance Claims
Before we start the process of applying for a health insurance claim, it is essential to carefully understand what a health insurance claim is and how the process works. A health insurance claim is a formal request which is made by the policyholder to their insurance provider for inclusion or reimbursement of vast clinical expenses which are incurred due to illness, injury or any other emergency.
Whenever you are visiting any healthcare provider or go to any hospital to get medical services, the healthcare provider generates a long long bill for the services received.
This hefty bill includes basic details such as the medical services provided, the cost of each received service, and the patient’s information like name, age etc. The healthcare provider then submits the generated bill to the health insurance company for payment.
The health insurance company reviews and surveys the health insurance claim to determine if it meets the insurance policy's coverage criteria. If the claim is approved, the insurance company either pays the healthcare provider directly or reimburses the policyholder for the covered medical expenses which basically depends on the type of insurance plan.
Steps to Apply for a Health Insurance Claim
1. Keep Detailed Records:
The first and foremost step in the process to apply for a health insurance claim is to maintain proper and detailed records of all medical expenses made. This includes health care bills, receipts, doctor prescriptions, and any other relevant documents which could be helpful in making the claim.
2. Understand Your Policy:
It is vital to properly familiarize yourself with your health insurance policy. It includes various terminologies such as coverage limits, deductibles, copayments, exclusions etc. To understand what your health insurance policy covers and what not, will help you determine which expenses are eligible for the coverage.
3. Notify Your Insurance Provider:
In case of some insurance providers, you may need to inform or notify your health insurance provider before you recieve certain medical services or treatments. You must make sure to follow any pre-authorization requirements which are outlined in your policy. It will help you to reduce the probability of claim denials.
4. Submit Claim Forms:
You must obtain and complete the necessary health insurance claim forms from your insurance provider. These claim forms typically require important information such as the policyholder’s personal details, the insurance policy number, date of service, description of the medical expenses made, and the healthcare provider's information and data.
5. Attach Supporting Documents:
You must not forget to attach copies of any other relevant documents along with the health insurance claim form. These may include documents such as medical bills, any required invoices, receipts, doctor prescriptions etc. If you are providing proper documentation to the insurance company, it makes it easier for them to review the claims process and helps you avoid any claim denials.
6. Submit the Claim:
Once you are done with all the documentations and data gatherings, submit the completed claim forms and supporting documents to your health insurance provider through the preferred method which are mentioned in your insurance policy.
This may involve mailing the documents to the health insurance provider or it might be submitting them online through the member portal of health insurance provider, or using a mobile app, if any.
7. Follow Up:
Once you have submitted the health insurance claim, you must not just completely forget about the health insurance. You must follow up with your health insurance provider to make sure that it has been received and is being processed. You must stay updated with the status of your health insurance claim.
Common Mistakes to Avoid When Applying for a Health Insurance Claim
While you are applying for a health insurance claim, here are some of the common mistakes you must avoid:-
Incomplete or Inaccurate Information: It is must to ensure that all the required fields on the health insurance claim forms are filled out accurately and completely. If in case, there is any missing or incorrect information, it could result in the health insurance claim being rejected.
Missing Deadlines: In the busy schedule of today’s life, it is not so common to forget some stuffs. The deadlines can be missed sometimes. But you must give proper attention to the deadlines. Forgetting these can result into any missed claims.
Failing to Obtain Pre-Authorization: As already told above also, some insurance policies of some health insurance providers might require pre-authorization for certain medical services or treatments. Failure to obtain pre-authorization could sometimes lead to claim denials.
Tips for a Smooth Health Insurance Claim Process
Here are some of the tips you must follow to ensure that a smoother health insurance claim process.
Keep Organized Records:
You must maintain proper records of all the medical expenses made. These may include several bills, receipts, and medical correspondence with your insurance provider.
- Know Your Policy: It is essential to know all the in and outs of your health insurance policy. You must familiarize yourself with your health insurance policy. These must include all the related terms such as coverage details, exclusions, inclusions, deductibles etc. You must properly comprehend the claims procedures.
- Communicate Effectively: It is must to stay in touch with your healthcare service providers. The insurance company should be also in proper communication with you to address any questions or concerns promptly.
- Be proactive and Seek Assistance if Needed: You must be aware and updated of all the things related to your health insurance claim. It is must to know about the status of your claim and must follow up with the policy providers. In any case if you are not sure about any aspect or things related to the claims process, you must seek assistance and help from your insurance provider.
Benefits of Properly Filing a Health Insurance Claim
Some of the benefits of properly filling a health insurance claim are stated under:-
- To properly file a health insurance claim gives you financial protection. It covers you against the high and hefty costs of medical care. It helps you to mitigate the heavy financial burden on individuals and families.
- Having a health insurance coverage allows people to access necessary medical services and treatments from the best possible medical care centers. It can be done without worrying about affordability.
- The mental comfort of having health insurance coverage and having the ability to file claims for eligible medical expenses is a great peace to the mind. This might help you lighten up the situation of high stress.
Conclusion
Now, we think it's pretty clear what to consider when buying a health insurance policy and how to approach various aspects of it. What are the steps and ways to get a health insurance. You can also use health insurance premium calculators to maximize the benefits of health insurance.
Afterward, mentioning your details and uploading the required documents, you can easily avail of your selected health insurance plan without any hassle.
