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Health Insurance Claim Settlement Procedure

Health Insurance Claim Settlement Procedure

In Health insurance mainly two types of claims are raised

1. Claims pertaining to cash less

2. Reimbursement of medical expenses

Claim Procedure for Cashless Health Insurance

1. For availing the cashless facility, first the insured visit the hospitals which are covered in the network of insurance Company.

2. Hospital obtains details from the customer and verifies the details along with the insurance details and send the intimation to the insurance company

[Post Image Courtesy of Vichaya Kaitying-Angsulee at FreeDigitalPhotos.net]

3. On receiving the intimation from the hospital, the insurance company either approve the claim and authorise the hospital to carry out the treatment under cash less scheme. In some cases, the insurance company may ask for some additional information and even deny for the claim.

4. After getting the necessary authority from the insurance company, the hospital carry out the treatment without any deposit and get the settlement of bills from the insurance bills. Here it is pertinent to mention that the liability of insurance company is limited only the amount insured and if the bill for treatment is more than the amount insured, the balance needs to be recovered from the customer

Claim for Reimbursement of medical expenses

In the cases where the customer does not use the cashless health insurance, he raises the claim for reimbursement of medical expenses incurred.

Insurance Law And Practice - ICSI

About Author Mohamed Abu 'l-Gharaniq

when an unknown printer took a galley of type and scrambled it to make a type specimen book. It has survived not only five centuries.

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