Simplicity of Health Reimbursement Claims

Do not worry about your health cover, claim will be paid if its admissible under your policy and held valid

Simplicity of Health Reimbursement Claims
Simplicity of Health Reimbursement Claims
Bhaskar Nerurkar - 06 September 2021

Covid-19 has changed our lives, one way or another most of us have been impacted by the pandemic. It has once again exposed the fragility of our system and has shown us that calamities can hit us anywhere, anytime. While there is not much that we can do to avert the unforeseen itself, but we can definitely seek cover against the unexpected.

Covid-19 has underlined, yet again the importance of health insurance and has increased the level of awareness for a health cover amongst the masses. People between the age group of 25-45 are particularly showing a heightened level of interest in health insurance and are looking for the right product to cover themselves and their families. The increased level of enquiry for health insurance is a good trend, and I realized there are few myths surrounding the product. One such misinformation is regarding the claims settlement process.

There are two ways to settle a health claim, cashless and reimbursement. In the cashless settlement, as the name suggests the payment is made directly to the hospital by the insurance company. However, a cashless facility is only available in certain network hospitals, as per the provider’s agreement with the insurer. Whilst the majority of network hospitals are present in Metros and Tier I cities; Tier II and rural locations have scarce cashless ties ups and reimbursement has become a preferred mode of a claims settlement.

The general perception is claimed reimbursement is a tedious, tiresome, and complicated process. Many people believe that health insurance is a product better suited for metros and bigger towns simply because smaller towns have fewer network hospitals. Nothing can be farther from the truth. A reimbursement claim is not as complex as people perceive it. Health reimbursement claims can be filed in just a few simple steps.

To give you an overview of how to file a reimbursement claim:-

To begin with, the initial payment has to be made by you (the insured), make sure to collect all the original documents, hospital bills, discharge summaries, and reports. Please note that original bills are mandatory for claim settlement. Also, it is advisable to keep a copy of all the original documents for future reference. To initiate the process, you have to fill the Health Reimbursement claim form along with bank account and NEFT details. Submit these documents to the nearest branch office of the insurance company

Many times it takes longer to settle a claim because of the insufficiency of documents. It is advised that you go through the claim form thoroughly, fill in all the details and submit the required documents. Your claim form has a checklist of these documents. Here is a quick list of some required documents to give you an overview.

  • Duly filled and signed claim form, this is easily available on the website of the insurer
  • Original discharge summary
  • Original hospital bill with a detailed break-up
  • Original payment receipts
  • Lab and test reports (MRI/CT scan/ECG)
  • A first consultation letter from the doctor
  • Bank details
  • Photocopy of ID (PAN card /Aadhaar card /Passport)
  • Internal case papers, if available

Make sure to give your correct mobile number and email ID so that insurer can easily communicate with you if required. It is prudent to keep a track of all communications with the insurer hence it is better to send the documents via registered post or courier. Today, most insurers have apps where you can upload your reimbursement document to initiate the process and courier the original documents later. This is especially helpful during Covid when it is taking longer to courier the documents.

Once you submit the claim form along with the bills, the insurer verifies the claim at their end to access the validity of the same. After the claim is verified, it is processed quite smoothly and the payment is made to your registered bank account.

To conclude, there is nothing complicated about a reimbursement claim, and one should avoid hearsay. I suggest that you take health cover without worrying about the claim, so long the claim is admissible under your policy and is held valid the claim will be paid. As the insurance companies are reaching out to the furthest corner of the country the number of cashless tie-ups is only going to increase. Till such time one should not wait to buy an insurance cover.

The author is Head – Health Claims, Bajaj Allianz General Insurance

DISCLAIMER: Views expressed are the author’s own, and Outlook Money does not necessarily subscribe to them. Outlook Money shall not be responsible for any damage caused to any person/organisation directly or indirectly.


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