Decode the Health Insurance Claim Process


Understanding which health insurance plan suits you the best is necessary or you will end up purchasing a policy which doesn’t fit your requirements. Especially if you’re purchasing a health insurance policy for the first time, you must do your research well before settling for any policy because the terminologies might confuse you a bit.

You can easily find a health plan for every citizen with each one having its advantages and disadvantages. Also, you must know the inclusions and exclusions of various plans so that you purchase the best health insurance policy. But most importantly, you should be well-versed with the claim process or your insurance policy will not be as beneficial.

Here are the two types of claims that you can make:

  • Cashless Claim
  • Reimbursement

Let us read about their processes in detail:

Cashless Health Insurance Claim


  1. Approach your preferred insurer’s network hospitals to avail complete cashless facility whether on an individual insurance policy or family floater health insurance
  2. Your details will be verified by the hospital and the duly filled pre-authorization form will be sent to your insurance provider
  3. The details of the pre-authorization request will be verified by your insurer with the policy benefits and the decision will be declared to the healthcare provider as soon as possible

The insurance company can then accept or reject your claim.


On Claim Approval

  1. If your cashless claim gets approved, your insurer will send the first response to your healthcare provider as soon as possible.
  2. All your hospital bills will be directly settled by the insurer.

In case of doubts

  1. The healthcare provider will then receive a letter of query and ask for more important information which can help the insurance provider forward the health insurance claim process even faster.
  2. After the additional information is received, your healthcare provider will receive a letter of authorization in less than 7 working days.
  3. The network hospital will then start with the treatment while you can sit back and relax without worrying about the medical expenses.

On claim denial

  1. If your claim gets rejected, your healthcare provider will receive a letter of denial from your insurance provider.
  2. The hospital bills remain fully payable; keeping that in consideration, the healthcare provider will ask you if it should continue with the treatment.
  3. However, there is still a ray of hope as you can file a claim asking for reimbursement later.

Health Insurance Reimbursement Claim

  1. You must collect the documents related to hospitalization and submit the original copies to your insurer.
  2. A customary verification of the necessary documents will be carried out.

In case additional information is required

  1. In this situation, your insurer will send you prior intimation regarding the same so that you have enough time to provide further information.
  2. After the documents are received by the insurer, leave it to them to take care of the claim settlement process.
  3. However, if you still did not provide them with the pending paperwork, you would receive a maximum of three reminders.
  4. If the paperwork remains pending, the insurance company will have to close the claim and send you a letter that states the same.

On claim approval

  1. The insurance provider initiates a customary verification of your documents to check authenticity.
  2. If the documents are validated, the payment will be released by your insurer within 7 working days.
  3. In case your claim does not fall within the policy’s purview, it will be denied and a rejection letter will be sent to you.

Once you get a thorough understanding of the health insurance claim process, you’re good to go. This entire process can be done online with ease. You can even purchase health insurance plans that specifically cater to your needs. For example, if your family consists of aged people, you can purchase health insurance for senior citizens online as well. Make sure that you follow the steps correctly while buying the health insurance plan.

You may also like


Leave a reply


More in Finance