Finance

Claim Process for Cashless & Reimbursement Health Insurance Claims

When an individual gets hospitalized, it affects not just the patient, but the entire family in one way or the other. For many individuals, hospitalization could be stressful because of the ever-increasing medical costs. For situations like this, health insurance policies work as a support system.

The insurance companies assist at the time of claim settlement. It also helps in managing the stress of the insured person. For the claim settlement to be smooth enough, the insurance companies have tie-ups with hospitals. These hospitals are known as network hospitals.

To know in detail about a similar type of arrangements in the field of medical insurance in India, read ahead.

  1. Non-network Reimbursement

If you are hospitalized in a non-network hospital, then all the hospital bills will have to be paid by you. After you have paid the bills, the insurance company’s role will come up. You will have to submit the invoices to the insurance company once you’re done paying the bill, after which their verification will be conducted. The company will then reimburse the insurance claim amount (as computed by their claims team), once the bill as well as the claim, are found to be authentic.

  1. Network Reimbursement

This one is just like the clause mentioned above in respect to the reimbursement clause. The insurance company provides no cashless facility. But, as the insurance company has a basic tie-up with the hospital, the process of claim settlement can be smoother in comparison with a non-network hospital.

  1. Network Cashless

In this option, you won’t be required to pay the hospital bills upfront. Therefore, there isn’t any reimbursement clause involved. The bill will be settled directly with the hospital by the insurance company. You will only need to pay the nominal charges.

While knowing about these options is important, it is equally beneficial to know the insurance claim process to file claims quickly and efficiently.

Why is a network of hospitals important?

In order to process claims swiftly, the insurance companies have a vast network of hospitals. They very well know about the functions of the hospitals because they have a tie-up. They are also well-versed with the services that are offered. Due to this, the process of claim verification becomes effortless.

Why would hospitals want to tie up with the insurance company’s network?

You would visit a network hospital if there were any health hazard when compared to a non-network hospital. Hence, network hospitals get a competitive advantage in a scenario like this.

Online health insurance

Online facilities make life easy for you. You no more have to worry about visiting an insurance company’s branch office for availing health insurance. This can also be done easily sitting in the comfort of your home by simply visiting the insurance company’s website. You can easily read, compare, purchase and get insured. It is also possible to go through the various health insurance plans such as health insurance for senior citizens or a family health plan, compare them as well as calculate their premium online.

If at all, you are unable to understand the inclusions and exclusions of the policy, then simply contact the insurance company’s call center to get all the answers. Read all the terms and conditions carefully, and make an informed choice when you purchase your health insurance.

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