Health Insurance Claim Process Explained
Knowing how to file a health insurance claim before you need it saves stress during medical emergencies. Here's a complete guide to both cashless and reimbursement claims.
Cashless Claims
Available at network hospitals. Steps: (1) Show health card at hospital, (2) Hospital sends pre-authorization to insurer, (3) Insurer approves/rejects within 2-4 hours, (4) After treatment, hospital bills insurer directly, (5) You pay only non-covered items. Best option — no out-of-pocket expense.
Reimbursement Claims
When using non-network hospitals. Steps: (1) Pay hospital bills upfront, (2) Collect all original bills, prescriptions, discharge summary, (3) Submit claim form with documents within 15-30 days, (4) Insurer reviews and settles within 30 days. Keep all originals.
Common Rejection Reasons
Pre-existing conditions (within waiting period). Non-disclosure of medical history at purchase. Treatment not covered (cosmetic, dental in most plans). Policy lapsed due to non-payment. Incorrect or incomplete documentation.