What is the process of raising health insurance claims?

What is the process of raising health insurance claims?

May 17, 2022 0 By ritikasharmaemail758

The process for filing claims to insurance companies has been simplify over time for customer ease. Top providers like Aditya Birla Health Insurance, Bajaj Allianz Health Insurance, Star Health Insurance, etc., have a well-defined system for their claim process. They usually have representatives to clarify customer doubts about filing claims; for example, you can contact the support staff on the Aditya Birla Health Insurance customer care number to help with health insurance claim queries. 

There are two types of insurance policies that define the process of claim filing with your insurance provider. In a defined benefit plan, you get the sum assure irrespective of the expenditure. Whereas an indemnity-based plan covers the cost of expenses incurre, with the maximum limit being the cover amount in the policy. 

Being an insurance buyer, you must know the different kinds of processes for claim filing.

Here are a few details on how to file an insurance claim in different scenarios:

Defined benefit plans

Defined benefit plans usually contain critical illness health insurance policies, surgical benefit policies, etc. In this case, the insurance company disburses the whole claim amount once the cover disease is diagnosed. Insurance providers provide these plans as a floater or rider along with the life insurance plan. 

Once the critical illness is diagnose and the terms and conditions of the plan are satisfy, you can file a claim along with the documents or inform the insurance company of your intent for filing a claim. Companies such as aditya birla health insurance customer care number will provide you with a unique claim reference number once the process completes.

Indemnity plans

Policies that fall under the umbrella of indemnity plans have two ways for filing claims:

Cashless claim process

The insurance provider usually facilitates a cashless claim settlement process at their network hospitals. In this process, the insurers directly settle the claims with the hospital as it falls in their network hospitals. Insurers will either have their representative at the hospital or a third-party administrator (TPA) to assist you in this process. 

The policyholder still has to pay for the expenses incurre in the list of exclusions of the insurance plan. To process the claim, they also have to carry the require documents for verification, such as government verify ID, PAN card, policy details, etc.

Reimbursement mode claim process

In this process, you incur the cost of medical expenditure yourself while getting treat. Later, you can file for reimbursement with the insurance company for the expenses incurred, irrespective of whether you get treatment in a network or a non-network hospital.

The policyholder should inform the insurance company about the treatment process beforehand if it is pre-planned. If not, they should notify them about the same as early as possible post the treatment. 

You must also remember to file a claim for the pre-hospitalisation expenses, as most plans cover these costs. You can either notify the insurance company in advance or once you get discharge from the hospital. Usually, 30 days of pre hospitalisation expenses are cover under a health insurance plan. Although the major treatment/surgery process is cashless, the additional costs incurred need to be filed separately with the insurance company, Bajaj Allianz Health Insurance or any other provider. 

This information will come in handy when you have to file for any insurance claim in the future. You must read the details provide by the insurer for their respective claim processes as there might be slight variations, and you can clarify any doubts on the phone. You can connect with their support staff for particular queries. For example, you can connect on Aditya Birla Health Insurance customer care number for health insurance-related queries. 

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