It is a great feeling to know that you and your loved ones are covered under an expert family health insurance plan. It is even better when the insurer provides cashless services at a large number of network hospitals. It relieves you of the pressure to provide substantial cash when there is a medical emergency. But, are you adequately aware of the procedure of raising a cashless claim on your family plan? A lack of familiarity with the same can lead to a stressful situation when it is time to file claims. Know how to raise cashless claims in a step-by-step manner with this article.
- Inform the insurance company
On admission to the network hospital, the first thing that you have to do is inform the insurer. You can do so through the TPA (Third-Party Administrator). If the admission is a planned one, then you can inform the TPA 2 or 3 days prior. Here, you may have to quote the number on your health card which had been given to you at the start of the health insurance policy.
- Fill the cashless treatment form
Network hospitals have a cashless treatment form available at their help desk. You can mention the name of your insurer and access the same. Fill the form correctly, providing the required details wherever necessary. You also need to get the form certified by the doctor appointed for the case to take the family health insurance claim process further.
- Send the form to the TPA
Once the form is filled, send it to the TPA associated with your health insurance policy. You can do it physically, or through email or fax. You are also required to provide medical proofs and other documents that substantiate your claim.
- Assist in the verification of your claim
After receiving your claim, the TPA will attempt to verify its authenticity. They may also contact the hospital or ask you for additional medical records. Based on these and the coverage of your policy, the TPA will decide to accept or reject the claim. If your claim is rejected, do ask why and see how you can raise a claim again. Do not worry though as the likelihood of your claim getting rejected is quite less if it is a genuine one.
- Check for the inadmissible charges
While the TPA settles a large part of the hospital bills with the hospital directly, you can check the inadmissible charges that are to be paid by you and arrange them in advance.
Keep these tips in mind for a better family health insurance claim settlement:
- If you are in an unfamiliar area, contact the customer care of your insurer and they will inform you of the nearest network hospital.
- Along with yourself, keep your family members aware of the claim settlement process as well so that they can do it independently when required.
- Follow the guidelines such as informing the insurer within the given time, avoiding excluded hospitals, storing the health insurance policy records in an accessible place, and so on.
A reliable and cooperative insurance company with a solid claim settlement ratio can ease your financial burden to a great extent, especially when it comes to cashless claims. Be an informed policyholder so that when a medical emergency strikes, you can give your attention where it is required – to rest and recovery.
