Understanding the health insurance claims process step by step

Almost every young professional understands the importance of having a health insurance policy. We rely on these plans to cover mounting medical expenses during an emergency. However, understanding how to file a health insurance claim while helping a loved one through a health issue can become overwhelming. Understanding the claims process can help you stay calm and complete your paperwork quickly during an emergency. Let’s explore our step-by-step guide on how to file a claim against your health insurance plan.

Insurance companies facilitate cashless claims at network hospitals. The process is easy since the hospital and insurance company coordinate directly, leaving the policyholder free to focus on recovery. At discharge, they only have to pay the excess and deductible charges.

Policyholders can get the required treatment, but they pay from their pocket. After discharge, they can submit the medical bills with their claim request, and the insurance company settles the covered amount with them.

Policyholders who must undergo treatment for a covered illness or disease can select their preferred network hospital. They must visit the hospital’s billing and estimate department to receive an estimate of the procedure. Then, they can approach the Third-Party Administrator (TPA) desk with the doctor’s notes and estimate. The TPA desk will use the given estimate to ask the insurance company for approval. You should complete the process at least 72 hours before hospitalisation.

Dealing with a medical emergency can be scary and overwhelming. Once you get admitted, have a family member visit the TPA desk with your health card and medical paperwork to inform them about the hospitalisation. They will contact the insurance company and get the required approval. During such cases, you may have to make an initial payment for treatment until you receive the required approval.

Your insurance policy may cover the entire cost or only part of your treatment. The hospital will issue bills periodically and request payments for any amount your policy will not cover. They also contact the insurance company to request additional approvals based on your treatment.

When you’re on the mend and ready to go home, the doctors will provide a discharge summary. You have to submit it to the TPA desk, which will ask for final approval from your insurance company. Receiving the approval can take almost three hours. Once the hospital receives confirmation from the company, they will issue a final bill and request you to pay for whatever your policy does not cover. Some hospitals may also ask for a 10% deposit of the approved insurance amount. They refund it once the insurance company settles the claim amount with them. You must submit a cancelled cheque to get the deposit returned to your account. Once all the paperwork and payments are complete, you can return home and focus on your health.

Contact your insurance company to inform them about your upcoming procedure or hospitalisation. If you have a policy from Zuno, you can e-mail support@hizuno.com on call on our toll-free number 1800 12000, to update us. Ideally, get in touch at least three days before you get admitted.

Medical emergencies are incredibly unnerving. Once you get admitted or admit your loved one, have somebody contact the insurance company. Most insurance companies have a 24x7 toll-free number you can call or provide an e-mail ID for instant notifications. Try to let your insurance company know within 24 hours of admission.

You must pay for all hospital expenses from your pocket during treatment. Remember to file all the bills and doctor’s notes carefully to submit them with your claim request.

The doctor will provide a discharge summary before releasing you from the hospital. File the discharge summary with the rest of your bills and prescriptions.

Next, submit the claim form and all the documents to the insurance company. You can find a copy of the form online on the company’s website. Or, you may have an option to complete the form and upload documents directly from the smartphone application.

After the insurance company receives the paperwork, they will verify the bills and notes. They will review the claim request and determine what your health insurance policy covers and what it doesn’t. Finally, the insurance company will approve the covered amount and issue a reimbursement to your account.

Arming yourself with adequate information about the claims process empowers you to prepare for emergencies. At Zuno, we offer comprehensive coverage, customisations with add-ons, and quick cashless claims at network hospitals across India. Visit the Zuno website to evaluate our coverage options and find the ideal policy for your needs.

ARN: Zuno/Blog/Understanding health insurance claims/06/24/06.

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