Filling a Health Insurance Claim? Focus on These 4 Key Points


Filling a Health Insurance

The process of filing a health insurance claim can be extremely overwhelming. Generally, the claim forms are complicated. Hence, even with all the help online, a majority of people find filling up these forms correctly a challenge. So, if you too are struggling with filling a health insurance claim form, don’t worry. You need to focus on these 4 key points.

1. Treatment Category

Standard health insurance claim forms, classify treatments as illness, injury or maternity. Claimants are often confused between the first two subcategories. Illness comprises medical management cases, day-care procedures and surgeries. The supporting documents required for each of them are different. 

Injury includes self-fall, drunk and driving accidents, assault, poisoning etc. It matters if the police were involved or not, i.e. an FIR was filed or not or whether the hospital registered it as a medico-legal case. You are required to provide appropriate and sufficient documentary proof to support your claim if claiming under this subcategory. 

2. Claim Amount 

A majority of people claim an amount which doesn’t match their hospital bill value. This may be due to certain discounts which aren’t highlighted in the bill or if the person is claiming only partial amount of the bill. To avoid making mistakes, list down all the bills you want to claim and add up their total value. The claim amount must match this total value. All the supporting documents should be submitted as evidence. Even payment receipts should be submitted wherever possible. If the bill and receipt amounts differ, justification from the hospital should be documented with the claim. 

3. Bank Details

Mostly, the claim is always in the name of the primary policyholder. The person whose name is registered on the policy by the insurance company is to be filled in the slot of primary policyholder name. Remember, the name should be consistent in the KYC and all the bank documents. 

For individual retail policies, the proposer in the policy is the primary policyholder who himself or herself may not be covered in the policy. For corporate policies, the employee is the one who is primary insured or the primary policyholder. The claim amount is reimbursed in the primary policyholder’s account. Many people mention the patient’s bank account details even if he or she may not be the primary policyholder. This delays the claim process as the insurance company raises a query with the bank regarding the mismatch between the names of the account holder and primary policyholder. 

4. ID Numbers

Generally, insurers tag a claim to the customer with the help of an ID number. People collect several insurance cards over years. Often they enter old ID numbers instead of the number of the period for which they are claiming. Also, a majority of corporate employees enter their employee ID instead of their health insurance ID number. They also forget to link the claim form to their corporate name. To avoid making mistakes in this field:

  • Ensure that the insurance card is of the period for which claim is to be filed. You can also call the customer care helpline of your insurance company. If their executive identifies the patient name with the provided ID number, it means that the number is correct.
  • If you are mentioning your employee ID, remember to mention corporate name somewhere on the form in a way that it is visible. Although, this might be a risky way for filing claim. Hence, always prefer to mention your correct insurance ID number only. 

These 4 are the most common areas of mistake due to which health claims often gets rejected or delayed. If you understand them better, you are less likely to make mistakes. If you still lack confidence, you can always seek expert help.

Author Bio:

Anuj-JindalAnuj co-founded SureClaim to fix the broken claim experience of insurance customers. He believes technology can play a major role in empowering customers. His understanding is shaped by his decade long stint in healthcare and health-tech companies.

Image credits: The copyright for the images used in this article belong to their respective owners. Best known credits are given under the image. For changing the image credit or to get the image removed from Caleidoscope, please contact us.


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