How to fill up your health insurance claim forms.

Having to get hospitalized is an inconvenience and then having to go after your mediclaim insurer for getting your hospitalisation expenses reimbursed is a bigger headache. Is it true? The reality is that if you follow certain simple steps then the whole process of insurance reimbursement become a piece of cake!

The first and foremost thing you have to keep in mind is that you need to ensure that the name of the patient in all hospital records and documents is entered correctly as in the policy document. We have come across innumerable instances where the name of the individual on the policy document would carry one surname and the hospital records have a different surname. As far as the insurance company is concerned, these are two different people and would refuse to process the claim and would further ask for documents to prove that both are one and the same.

Discharge summary is the most important hospital record of all. This document summaries the cause for hospitalisation, the course of treatment that was given to you and contains the date of admission and discharge. Ensure that the discharge summary contains the signature and the seal of the treating doctor and the seal of the hospital.

Keep all your bills, reports and receipts safely. Never throw away even the smallest bill/receipt thinking it is not important. Always keep in mind that if any test or procedure has been done in the hospital and you plan to claim the cost, then the insurance company would definitely be asking for the test results or scans and X-rays. Investigative reports are always required by the insurer to settle any claim. While submitting these receipts, bills and reports ensure that they have the seal of the hospital.

Every claim must be accompanied by 2 claims forms and one NEFT form. Out of the two forms, Claim Form A has to be filled by the insured where as Claim Form B has to be filled by the hospital. Form A must be filled with the policy number as well as your health card number. These two numbers act as your reference number and allow the insurance company or the TPA to track down the claim. Please remember to fill the date of admission and discharge correctly as mentioned in the discharge summary. Please write down the total amount you plan to claim from the insurer if not the bill wise amount. Claim Form B is filled by the hospital’s insurance desk and would require the signature and seal of the treating doctor. Every hospital has an insurance desk that will help you to get the required signatures and seals on the claim document.  The NEFT form asks for the bank details of the insured so that the approved claim amount can be transferred directly to your account. Most insurance companies insist on a cancelled cheque leaf also to verify the correctness of the account details. Please ensure that the account must belong to the insured and not to a third party. Claims forms are available directly from the insurance company or your broker

Before submitting this set of claim documents it is highly advisable to get a set of photocopies for your reference just in case the original set gets misplaced or lost when couriered or from the TPA.

The completed set of claim documents needs to reach the designated TPA of the insurance company. Your health card would have the contact address and details of the TPA who is responsible for servicing you. If you have taken the policy through an insurance broker, then you can submit the documents to the broker who would take care of the rest. It is in such situations that you realize the value of having a broker on your side to guide you and follow up your claim.

Take a little care to fill up the forms correctly and it will save you a lot of hassles later on. Remember, a stitch in time saves nine!