Before 3 month I got call from my far relatives who living in Maharashtra. Reason of call was they are not getting their reimbursement claim approved from their Insurance Company from almost 9 months in their mother’s mediclaim Policy. When i got policy and claim details from him and check with Insurance Company I know there was a query generated from insurance company which my relative do not know about it and he getting frustrate because he don’t know process of mediclaim reimbursement claim properly.
Friends, In My 17 years of carrier, I saw many similar cases where policy holder don’t know exact process of mediclaim reimbursement claim and where to get status and then he end up with claim rejection or delayed reimbursement claim approval. After that experience he have negative thought about particular Insurance Company or some time about whole Insurance Industry . That why I decide to write post on this topic where I will give complete guide of mediclaim (Health Insurance) reimbursement claim process step by step.Please note this process is almost common in all insurance companies.
Process of Reimbursement Health Insurance Claim Step by Step.
Claim Intimation to your Health Insurance Company (Very Important step of reimbursement of health insurance claim
It is very important step to intimate your health Insurance Company regarding hospitalization within 24 hours of hospitalization . if you don’t give intimation on time your Insurance Company can reject claim. In case if you give proper explanation regarding reason of delay intimation, Insurance company can consider. My advice is try not to delay to give intimation.
How to give Claim Intimation to Insurance Company
If you read your mediclaim policy . Your insurance company given multiple choice to give intimation like visit their website and give intimation or call on their customer care number or via email. I strongly suggest always give intimation via mail, Because you will always have proof of intimation with date and time in your sent box. Yes I know if you give intimation number via call then give intimation number but sometime because of network problem you can’t receive confirmation message so best way to claim intimation is via customer care mail.
What Information are mandatory while Claim Intimation
While Intimation there are some minimum information you have to write while claim intimation like Policy Number, Policy Holder Name, Patient Name, Contact Number of person who Intimating,Date of Hospitalization, Cause of hospitalization, Name, Address and Contact number of hospital and also attached policy copy with this email. I have Make standard format of intimation email.Please find Image Below for same.
Prepare file and send it to Insurance Company/TPA
After done claim intimation you will need one claim form part -B which is filled by the hospital on treatment. You can download 
Where To Send File
Now you have done intimation email and patients is discharged now and file is ready .Now most important question is where to send file. Find you TPA (Third Party Administrator) address in you policy copy where they mention to send document in time of claim if you don’t find call customer care number and get. I personally suggest if you give file in any local office of insurance company branch always get acknowledge of file submission to avoid future dispute and if you send courier keep courier receipt till claim approve.
Follow Of reimbursement Claim
In starting of this article i have given an example of my relative actually he done mistake to follow-up with wrong person actually he follow up with his agent , we can’t say wrong person but he can’t get exact status from agent so, i will suggest contact with customer care every 3 days. Because in most cases there will be query in claim but policy holder don’t know about it.
so this above steps I guided how to get mediclaim reimbursement claim easily. If you still got any problem or doubt you can comment below or contact me direct from here.… . will guide you always.
Point to be noted – In my experience of 15 years I see people got frustrated if they know that insurance company raise query in their mediclaim reimbursement claim. Friends, don’t think negative if company asking for more information/document. Mediclaim is on of those product where more fraud is happening So, Insurance company always be assure that every claim they paid is Genuinely. Its beneficial to all stake holders. If you think still you cannot getting you claim approved? we are also giving service to process in claim contact us here