Want To Expedite Your Health Claim Settlements? Here Are 6 Basic Strategies

Navigating health claim settlement processes can be quite stressful especially when medical emergencies strike. The last thing you would want to face is a delayed settlement which can put a strain on your financial situation. While insurers provide coverage during medical treatment, ensuring your claim is processed efficiently requires some basic and strategic preparation.

Here are some expert-backed tips to expedite your health claim settlements:

1. Get Your Documents Right!

The first step towards ensuring a smooth settlement procedure lies in accurate and complete documentation. According to Shilpa Arora, Co-founder and COO of Insurance Samadhan, “Proper and accurate documentation is the backbone of successful claims as it can support individual cases and help them avail timely compensation without hassles.”

In fact, Arora adds, failing to furnish the required documents within the specified period can get one’s claim rejected immediately or lead to a short settlement.

To streamline the process, you should verify all the details in your medical bills to avoid discrepancies. “However, should not throw the medical bills after they are cleared as they are considered vital proof of healthcare expenses during the claim settlement process,” Arora informs.

Make sure you check following documents in both original and photocopies:

- Hospital Bills

- Cash Memos

- Medical Reports

- Diagnostic tests

- Prescriptions

- Hospital admission slips

- Discharge summaries

- In case of an accidental claim, you must submit an FIR copy along with the rest of the documents

Arora adds that individuals must give a serial number to all the bills along with an explanation note stating which one requires an early reimbursement. Some insurers may require individuals to submit their identity details such as Aadhar card, the doctor’s recommendation for hospitalisation in writing, and other supporting documents justifying hospitalization.

Therefore, keeping these documents handy could simplify the process for you.

2. Inform The Insurer On Time

Timely communication with your insurer is critical to avoid delays. Says Arora, “The insured or their family members must make it a point to inform the insured about their hospitalization within 24 hours in case of emergency admissions.”

As for planned surgeries, policyholders should inform the insurer 48 hours in advance. This is because a delay in informing the insurer or submitting documentation can extend the settlement timeline.

Similarly, you should submit or upload all medical bills within 30 days of discharge from the hospital. While different insurers may have varied timelines for claim intimation, it’s best to read the fine print of your policy to avoid missing deadlines.

3. Opt For Cashless Claims Over Reimbursment

Whenever possible, choose the ‘cashless claim’ option for your policy/settlements. Under a cashless claim, the insurance provider settles the bill directly with the hospital. This option is deemed faster than ‘reimbursement claims’ where the insured pays for the expenses first and gets them reimbursed later, making the process lengthy.

“In our experience, hospitals with a Third-Party Administrator (TPA) are more adept at dealing with claims efficiently and quickly. Hence, individuals may consider seeking treatment from a hospital with a designated TPA for smooth processing,” Arora mentions.

4. Choose A Network Hospital

To avoid any stiff or delays with your claim settlement post-treatment, it is advisable to get treatment in a ‘network hospital’.

Network hospitals are basically hospitals that are mentioned in the agreement while getting insurance from the insurance company. Typically, these are the hospitals where the insured can easily avail of cashless claims service.

The network hospitals would offer you easy cashless treatment, quality care and seamless claim settlement processes.

5. Track Your Claim And Raise Queries

Every insurer has a grievance redressal system put in place. Policyholders should use this to their advantage to track claim progress and raise queries accordingly if they notice any delays or unresolved issues. This not only ensures your case remains active but also maintains the transparency between you and your insurer.

6. Know Your Policy And Read The Fine Print

Understanding the specifics of your policy is crucial for you to avoid any unexpected hiccups. Every policy has its terms and conditions for claim submissions and hospitalisations. Familiarise yourself with the timeline for claim intimation, and required documentation, and know whether your policy covers specific treatments and what are the exclusions.

Policyholders should know that the timeline of settlement may vary based on the nature of the claim. To ensure the claims get settled as soon as possible, you should first make sure the relevant documents are kept ready and also inform the insurer about the hospitalisation or treatment at the earliest. Be ready to provide a complete set of documents on time, and furnish other information promptly. If issues arise, tracking your claim through the insurer’s grievance system or seeking expert assistance can help resolve matters quickly.