How do I claim health insurance benefits?

 

How do I claim health insurance benefits?

Insurance is an important requirement if you want to manage planned and healthy personal finances. Apart from having a proper emergency fund, having health protection is a good thing to have. Having insurance, your finances can be protected from the risk of loss that may occur when suddenly faced with a condition that requires large costs. for example, when you are sick and need a lot of money, or when one of the parents who are the breadwinners of the family dies due to an accident or the income of the family stops.

In general, there are two kinds of health insurance benefits, namely, compensation and benefits. For the claim amount plan, you can file or claim the costs that have been incurred up to the insured for certain diseases, according to the policy regulations. In a defined benefit plan, you are covered for certain diseases that have been agreed upon in the policy agreement.

You will get the sum assured if you make a contract agreement with one of the insurers and provide evidence that can be obtained. the sum assured is usually not paid at any cost, but by contracting a disease or illness by the provisions of the policy.

Cashless service or membership card at the hospital

every time you buy a health policy, the insurance company will provide a list of hospitals that are part of their partnership. If you are treated in one of those hospitals, you may be eligible for non-monetary benefits by showing your insurance card or electronic membership card at a hospital that supports this continuing treatment and at that hospital without paying cash.

One other criterion is that the medical condition or disease is covered as part of your health plan, depending on the amount you cover. The hospital sends all bills to the insurance company after the patient is discharged. And after assessing all the costs, the insurance company will pay the bill.

Another way to benefit from health insurance is by reimbursement. You can pay your medical and treatment costs first, then submit all bills to your insurance company, After the billing application, the insurance company will reimburse you for the costs you have made, based on your sum insured. Other facilities will be activated if the insured person receives treatment outside the network or an affiliated hospital, in an emergency or otherwise.

From when can claims be billed?

Almost all health insurance policies require patients to be hospitalized for at least 24 hours or more to qualify for benefits. It is also important to look at the validity of your health insurance plan. It must be ensured that your policy is still active and has not expired or you will not be able to make any claims against the costs you have incurred

While writing an insurance policy can take time or can be a bit tedious, there are a few things you need to keep in mind. Policy details such as restrictions on certain procedures, inpatient room rental limits, waiting periods for certain medical conditions, and policy exclusions are important. Health insurance plans often have waiting periods for certain illnesses or conditions so you should learn about them. Your insurance company may not accept a claim due to a pending illness or medical condition.

How do you get reimbursement for your claim?

Almost all hospitals that work with insurance networks have an insurance desk or a representative from the insurance that you can visit during your stay in the hospital. To use the cashless service facility, you must fill out a pre-approval form at the front desk to register for a hospital stay plan. In case of emergency admission or admission to the ER, notification can be made within 24 hours of admission. To receive a non-cash claim, only the insured's identity card is required along with the medical card. You only need to fill in the pre-approval form provided by the hospital's insurance department and other documents will be provided by the hospital's Third Party Administrator (TPA) department.

It is recommended that you discuss the details of insurance coverage with the hospital in advance before applying for hospitalization. This will avoid misunderstandings and omissions. Hospital staff will contact you when your coverage ends so that your claim or refund goes smoothly.

There are several documents that you must fill out and prepare for a smooth operation, documents such as a claim form filled out and signed by the insured, hospitalization notice, handling of your doctor, complete details of the final bill provided by the hospital, original bill and payment receipt costs before and after hospitalization.

The patient must receive all original hospital bills, which you must check to see if they are properly signed and stamped. You must also provide all medical reports, diagnostic reports, hospitalization reports, and any additional investigations and tests required. The most important requirement in submitting a refund claim is a summary statement. Be sure to send it with your claim. Before you submit the original documents, don't forget to make copies of all your billing documents, in anticipation of losing documents.

Your insurance company will study and assess and then accept the claim, they will transfer the claim amount to the account you specify on the form. Therefore, you should make sure that you have entered the correct details and double-checked them before submitting the form, as well as submitting any other documents referred to as conditions along with the KYC documents. If all the conditions are met it will be easier to get a claim and less likely the claim will be rejected.