The Health Insurance Claims come into place when direct payment or request for the
reimbursement for medical service is obtained. When you give your insurance identification
card for claim to the company it is not enough. This type of process can only be reimbursed
if you made the payment from your pocket followed by the timely submission of the medical
bills. The general process that needs to be followed to get the claim are mentioned below:
Process 1: To Obtain Personalized Bill-
The very first process for filing the claim is to get a bill in your name from the concerned
doctor or medical assistant. The bill should have the list of all the services and the amount
you have paid along with the unique code mentioned by the insurance company to get your
claim. After getting the bill it is quite simple to give a call to the provider and inform about
your claiming for health insurance. Henceforth the provider will forward your bill along with
little other information like the medical service date and your full name.
Process 2: A Completed Claim Form-
It is documented form by which you give more information to the insurance company about
the medical illness or accident that has happened. This form gives the idea to the company
that the illness in questions is covered under it or not, so the elaborate the form is it is
better for the claimant. All the forms have instructions and directions to be completed and
where they need to send. For any other query the insurance company can be contacted.
Common points covered on claim form:
- Date of Birth, Name and address of the claimant.
- Information about insurance like group and policy number.
The reason for doctor’s visit describing about the condition and background or if it is
concerning you or other family member covered under group insurance.
- Doctor’s Name Address to be mentioned.
- If the pre-payment done then needs to be mentioned.
One can attach more sheets to the claim form in order to explain each question.
Process 3: Keep a Copy-
It is always beneficial to keep a copy of the claim form so that you also have the correct
information that you have provided to the company. And after submitting the form do keep
the receipt as a proof that the form has been sent or been accepted by the insurance
company as the case may be.
Process 4: Check and Proceed-
Once all the information is assembled and claim form is duly filled then check if all the
requirements are completed then proceed and call the company and tell them about your
sending the form. Do inquiry about the documents that you are sending and the information
provided by you is complete or some other documents and additional information needs to
So after being satisfied you send the completed from as it won’t get rejected. Mostly the
forms have the address mentioned on them where you need to send them.
Process 5: Do Read the Fine Prints while waiting-
Generally the entire health insurance claim needs to be filed within 7 days from the date of
discharge form the hospital. The company can reject the claim if the forms and documents
are not as per their policy. And mostly the whole of medical expenses may not be covered by
the company. Do read and get the clear picture of your health insurance policy.
Hence after dispatching one can only wait and keep checks on the calendar keeping in mind
the time the company gave to settle the claim when you called them up. If you do not get
the claim in the given time call the company and take note of whom you spoke to date and
time and his position in the company and the assurance given by him which you can use if
further if more follow up are required.
Don’t be shy in doing the follow up by the company after the claim form is sent to
them to know that the documentation is complete or some additional things required. Or
even if you are anxious to know that what amount you are going to get from the company.
Thus keeping the above points and reading the policy documents correctly one can claim for
the health insurance and avail the benefits.