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Do’s and Don’ts For Filing A Health Insurance Claim

Updated On May 01, 2021

Health insurance is a necessity to deal with medical emergencies without taking a toll on one’s financial health. But, even with adequate insurance coverage, many people are still skeptical if they would get adequate coverage at times of emergency hospitalization. It is important to follow the claims settlement procedure as indicated by the insurer to avoid claims rejection and to get the insurance claims processed on time.

Process of Filing a Health Insurance Claim – Do’s and Don’ts

There are two ways to claim under a health insurance policy, namely on a cashless basis or on a reimbursement basis. For cashless claims, one has to take treatment in the network hospitals of the insurer. For insurance on a reimbursement basis, it is mandatory to submit all hospital bills to file claims. There are certain do’s and don’ts while filing a health insurance claim and they are discussed below.

Do’s For Filing Health Insurance Claims

Here are the things to do, to ensure a hassle-free claim settlement process in health insurance.

1. Inform the Insurer: Before getting hospitalized or within one day of hospitalization, it is important to inform the insurer regarding the diagnosis and the place of treatment. Those who are seeking cashless hospitalization should get treated in the network hospitals of the insurer.

2. Read the Exclusions Criteria of the Insurance: Read the terms and conditions of the policy and understand its inclusion and exclusion criteria. Preserve the policy copy in a safe place and make a list of non-payable items according to the policy and make necessary arrangements to pay for the same.

3. Understand the Waiting Period Clause: The waiting period is applicable for certain diseases for which the insurer cannot make a claim. This varies between insurers and policies.

4. Preserve All Bills and Documents: Those who do not avail of cashless treatment on a reimbursement basis should save all the hospital bills, reports, diagnostic tests, pharmacy invoices, etc., to make a claim.

Don’ts For Filing Health Insurance Claims

Certain don’ts should never be done while filing a health insurance claim.

  • The policyholder should be truthful regarding their health insurance claim and should not suppress any information related to their health condition.
  • No delay should be made while filing the claims with the insurer.
  • Hospitalization under 24 hours cannot be claimed.
  • Some daycare procedures are also covered under insurance but should be indicated in the policy.
  • Excluded conditions, according to the policy such as congenital diseases, sterility and infertility will not be eligible for a claim. Pre-existing diseases should be disclosed at the time of applying for a policy.
  • Claims related to alcohol-related hospitalization and corresponding treatment are not permitted.
  • No claims can be permitted for an expired policy.

Bottom Line

By following the above-mentioned do’s and don’ts of a health insurance claim, it is possible to enjoy a smooth insurance claim process. It is important to take all needed efforts and precautions while filing the insurance claim and keep the insurer informed regarding insurance claims, before getting hospitalized.

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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