CLAIM REIMBURSEMENT

CLAIM REIMBURSEMENT

Now a days, most hospitals are a part of the network of Insurance companies and hence, cashless treatment facility is available.

In case of emergency, let’s suppose you land up in a hospital where neither is this cashless facility available nor is the hospital in any way associated with your insurance company. You end up paying the hospital bill and then file a reimbursement claim with insurance company, to get back your money.

‘Claim reimbursement’ in Mediclaim means the reimbursement of hospitalisation expenses, pre and post hospitalisation expenses.

The following documents are required for filing a reimbursement claim.

  1. Claim Form – The claim form of an insurance company is available online. The claim form mostly has two parts. One part is to be filled by the Insured or policy holder and the other part is to be filled by the treating doctor/Hospital authorities. The important point here is that one must get the second form (Claim form-B) from the hospital authorities during the discharge process itself, to avoid extra visits to hospital later.
  2. Detailed Hospital Bill – The Patient/Insured must take a complete detailed bill from the hospital with a sign and stamp. The break up of all the charges should be mentioned in the detailed bill. If the treatment is taken as a package, then the package details must be obtained from the hospital on a separate hospital letter head with a sign and stamp.
  3. Payment Receipt – The Patient/Insured must keep all the advance payment receipts in original with himself/ herself during the hospitalisation period and a final payment receipt at the time of discharge. No duplicate receipt is allowed for reimbursement of claim.
  4. Discharge Summary – the Patient/Insured must obtain a detailed Discharge summary with correct name of the patient (as written in policy and ID proof), Date of admission and discharge and time of admission and discharge. The treatment details must also be mentioned during discharge in course in hospitalisation column. The Surgery details must also be mentioned as charged in the bill.
  5. Test Reports- The Patient/ Insured must collect and verify their test reports with bill. If the hospital has charged for any medical/ Radiological test then the test reports must be available with patient. Pending reports can be collected later on, if test results are awaited.
  6. Cancelled Cheque – A crossed/ Cancelled cheque of the policy holder must be included in the claim documents, so that insurance company can transfer the reimbursement claim amount directly into the account of the policy holder.

All the above mentioned documents along with the Claim form should be sent to the insurance company to its authorised address for initiating the reimbursement claim process.
Some claim form links are available here.