A guide to checking your health insurance claim status

A health insurance policy claim has several processes and does not end with submitting the claim form. Certain documents will be required to submit when raising a claim. You need to be proactively involved to ensure the claim is easily processed. It also eliminates the situations like lesser claim amounts, incorrect redirection of funds, rejections of ID, and many more.

It is important to buy a health insurance plan from a provider with more than a 90% claim settlement ratio. Typically, the best health insurance in India will always have a higher CSR (Claim Settlement Ratio). Hence, always compare the plans and check the insurer’s background before buying a health insurance provider.

What is a health insurance claim?

A medical insurance claim requests the insurance provider to provide the benefits and services covered under your health insurance policy. To claim a health insurance plan, you need to submit certain necessary documents as asked by the insurer. The insurance company, after verifying the documents, will settle the claim.

What are the types of health insurance claims settlement?

The health insurance policy aims to offer financial support in times of need. There are two ways by which the health insurance claim is settled –

• Cashless claim – Cashless claims are the more popular form of settlement. This is because if you are admitted and treated at the network hospital of the insurance provider, you do not have to pay anything at the time of admission. On admission, you must produce the cashless health insurance provided by the insurer, and they will do the settlement. Hence, you do not have to pay anything for the treatment.
• Reimbursement claim – In a reimbursement claim, the payment is initially made by you for the treatment, which the insurance provider later reimburses. To claim a reimbursement, you must present the bills, prescription, hospital discharge certificate attested by the attending doctors, etc. Upon verifying the documents, the insurer will credit the amount to your bank account. The reimbursement process starts within seven days of your discharge from the hospital.

What are the steps to file a health insurance claim?

The following are the steps to claim a cashless health insurance claim –

• Always read the terms and conditions of the policy before purchasing. This will help you reduce the risk of your claim getting rejected.
• Always choose a network hospital in case of a medical emergency.
• Get in touch with the Third-Party Administration (TPA), as they will help you fill out a Pre-Authorized Form (PAF) to approve your cashless health insurance policy.
• Also, you will be asked to show your Cashless Health Card and identification details.

The following are the steps to claim a reimbursement health insurance claim –

• At the beginning of the medical treatment, you must always inform your insurance provider to ensure the claim is processed smoothly.
• Fill in the necessary form and attach all the necessary documents, such as bills, medical discharge certificates, prescriptions, etc.
• The insurer might also ask for the attested fitness certificate from the attending doctor.
• Once the insurance providers receive the document, they will validate those and process the claim.

How to check health insurance policy claim status?

Once the insurance provider processes the claim, it is always important to check and track the claim status. This is because chances are the claim might get stuck or rejected due to some unforeseen reasons. Read below to know how you can check the health insurance claim status.

You can check the claim status of your health insurance policy both online and offline.

Online mode

• Visit the official website of your health insurance provider company.
• Click on the claim icon on the website.
• Click on the track claim status.
• You will be redirected to the page where you must enter the customer ID, policy number, claim number, and date of birth.
• Select submit.
• Now you can view your claim status.

Offline mode

• Visit the nearest branch of the insurance provider along with the necessary documents.
• Call the toll-free customer care number of the health insurance company and talk to a customer care executive, and they will tell you the claim’s status.
• Also, send them an email with your query with the policy number and other necessary details to the email address provided by them.

Now that you know both ways of checking health insurance claim status, it will be easier to check the status and contact the insurer if any issue is caused. Some insurance providers also offer claim status on SMS and chatbots. Before buying a health insurance policy, always ensure that they have an official website. This is because the best health insurance in India will always have a website to ensure customers can access all their features and services without hassle.

Disclaimer – The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.