Cost of medical treatment has increased significantly over the recent past. People have come to realize the importance of medical insurance to cover for the contingency in cases of unforeseen circumstances. There is also an increase in medical insurance premiums, resulting in people owning multiple medical policies; and that too from multiple insurance companies. However, just paying the premium for the medical insurance is not sufficient to cover yourself for uncertainty. You need to also understand the intricacies of the claim process in order to ensure that you are able to avail the benefits. Holding more than one policy is not bad if you understand how to use them aptly and making health insurance claims accordingly.
The first step starts right at the time of opting for the additional policy. One needs to disclosure the insurer about the existing policy. Failing to do so may lead to violation of insurance terms, resulting in rejection of claim. Next comes the process to file a claim with the respective insurers, in case a single policy is not sufficient to cover for the hospitalization expense.
Claim intimation process
In case of planned hospitalization, intimate in advance each of the insurance company about the upcoming claim. For emergency cases, claim intimation must be sent to the insurance company or the TPA within 24 hours. The intimation process is fairly simple – you can file an intimation by making a call to the customer care or write an e-mail.
Filing the claim
In the current environment, most medical insurance policies offer cashless claim process, and it is taken care and facilitated by the hospital itself. However, in case a single insurance policy is not sufficient to cover for the entire hospitalization expense, then you will need to file for the excess (as a reimbursement claim) from the other insurer. This could be tricky, as most insurance policy would require you to file the claim within a certain time frame (normally 30 – 45 days) from the date of discharge. Further, in case you undergo the treatment at a hospital where cashless facility is unavailable, then you may need to file for the reimbursement from both the insurance companies. Lets look at the cases
Case 1 – Cashless from the first policy and reimbursement from the second
Upon availing cashless facility from the first policy, intimate the hospital that you plan to claim for the additional reimbursement from another policy; and obtain a copy of all the documents and hospitalization records from the hospital. Following are some of the key requirements
· Claim form
· Copy of discharge letter
· Claim settlement letter from the first insurance company
· Signed copy of duplicate bills from the hospital
Case 2 – Reimbursement claim from both insurance policies
If you have to file for re-imbursement claim from both the insurance policies, the claim settlement process from the first insurer itself might result in time lapse and could result in delay in filing with the second insurer within the policy stated time period of 30-45 days. In this case, intimate both the insurers of the fact, that you will file a claim from both the policies. This will ensure that you are not penalised for not filing the claim within the stated time period of 30-45 days after the discharge; and you can ask for the following documents from the first insurer, to be able to file another claim with the second insurer.
· Copy of discharge letter
· Claim settlement letter
· Signed copy of duplicate bills from the hospital
The bottom line
Just ensuring an appropriate medical insurance coverage is not sufficient – when required, you need to be able to avail the benefits as well. Being aware of the terms and conditions of the policies; and the procedure for filing the claim is equally important.