An indemnity cover, also called Mediclaim, comes into effect during a medical emergency such as accidents, hospitalisations and treatment for critical illnesses. Depending on a policy’s terms and conditions, the insured can claim reimbursement for certain medical expenses. This article takes you through the Mediclaim reimbursement process to help you navigate through the claim filing with ease. Read on!
There are many times when patients or their families pay the bills from their pocket. After the payment, they contact the insurance companies for reimbursement. This process is known as Mediclaim reimbursement. This process is helpful especially during an emergency when there’s less time to look up Network Hospitals for cashless claims.
The mediclaim reimbursement will be applicable only in the following two instances:
Given below are the points that one needs to consider before choosing an insurer for investing in a Mediclaim:
Sometimes, people just do not have enough time to file claims early due to medical emergencies. Hence, insurers allow people to file cashless claims even after hospitalisation.
Given are the steps you can undertake to make claims during medical emergencies:
If you are too late to file for cashless claims, you should make sure to have all the original medical bills and file for a reimbursement.
Check if you have the following documents before filing a claim:
The steps to check the status of your reimbursement claim are given below.
Given below are the top reasons why a Mediclaim reimbursement claim can get rejected:
If your insurance claim is rejected, you can take the following actions to amend it:
Before taking any action, try to figure out your mistake with the claim filing. Providing wrong information, making claims outside the policy coverage, or lack of necessary documents are some common reasons behind this.
If your claims had incorrect information, you could ask your insurer about reinitiating the mediclaim reimbursement process. Take a look at what went wrong and make sure to not repeat the mistakes.
TPA representatives help with processing claims and assist policyholders. Contact him/her to help you with a solution and reopen the claim case to correct errors.
For smooth settlement, the insurer will require hospital bills, discharge summary and prescriptions. You will need to double-check if you have submitted all of these documents to the insurer/TPA.
If you have all the required documents to support your claim, you can send a formal letter with evidence about why your claim is valid. You can make multiple claim appeals or send your consulting doctor’s statement as further proof.
Given below are the things that one needs to keep in mind before filing a reimbursement claim:
Insurance agencies provide the option to get cashless claims or get compensated later. How long the mediclaim reimbursement process takes will depend on the insurer. Insurance companies that settle claims without hassles have a very high claim settlement ratio, indicating their commitment to helping customers.
Navi Health Insurance offers a very simple claims process and has an industry-leading claim settlement ratio of 97%. Download the Navi App from the Google Play store and get a policy that will settle cashless claims in only 20 minutes.
Ans: An effective way to fasten up the claim process is to avail of cashless claims. It ensures that the policyholder is not unnecessarily burdened by arranging cash at a difficult time. However, it is advisable for the insured person to go through the terms and conditions properly to make rightful claims.
Ans: This depends on the coverage amount which varies from one insurance provider to another. Reimbursement under a mediclaim will only be available for hospitalization expenses. A mediclaim will not provide reimbursement for daycare procedures and hospitalisation for less than 24 hours.
Ans: Yes. Your particular insurance policy will have several exclusions that you can find in the fine print. Usually, laundry charges, telephone charges, medical records fees, costs of toiletries, nebulisers, etc., are not covered.
Ans: Follow the given tips to prevent claim rejection:
– Have copies of all related documents
– Double-check the claim form for mistakes
– Check the terms and conditions thoroughly
– Keep your TPA/insurer’s contact details handy
– File for claims as soon as possible
Ans: It usually takes 2 to 3 days for insurers to settle claims. However, some insurance agencies offer instant settlement claims for up to a specific limit to make the mediclaim process more convenient.
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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.
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