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Filing a health insurance claim

business Updated: Jun 14, 2009 21:28 IST

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1. Full formalities

Submit the duly filled and signed claim form, hospital discharge certificate, doctor's consultation reports, bills, receipts, cash memos from hospital supported by proper prescription, test reports, attending doctor’s certificate, attending consultant's/ specialist's/anesthetist's bill and receipt, diagnosis certificate, and details of previous policies.

2. Follow TPA

In case of unplanned hospitalisation, inform the TPA as soon as possible and follow the steps as suggested by the TPA. Once treatment is complete get all the necessary documentation from the hospital and doctor. You will have to settle all bills out of your own pocket and get reimbursed by the Insurance Company.

3. Get clarity on coverage

For a planned hospitalisation contact the Third-Party Administrator of your health insurance policy and inform them of the planned hospitalisation. In case of the hospital in which you wish to take treatment is not in the TPA network, enquire from your TPA if the costs will be covered.

4. Know the small print

Insurance companies will not honour claims if the documents are not as per their terms. All health insurance claims have to be filed within 7 days of completion of treatment.