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Health Insurance

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About Health Insurance

Health Insurance acts like a saviour, offering essential financial protection during medical emergencies. With Health Insurance, you and your loved ones can rest assured knowing that unexpected healthcare costs are taken care of, ensuring your well-being is prioritised. When a person encounters a situation where they cannot access this vital coverage, it might create significant financial strain along with feelings of worry and insecurity.

Here are specific issues that people may encounter while claiming health insurance:

  • Incomplete Documentation: Many policyholders submit incomplete documents, leading to claim rejection or delays.
  • Pre-Existing Conditions: Some policyholders may not disclose pre-existing conditions when purchasing the policy, leading to claim disputes.
  • Waiting Periods: People might not be aware of waiting periods for specific treatments, leading to claim rejection if made before the waiting period ends.
  • Claim Denials: Insurance companies may deny claims for various reasons, such as incomplete information, lack of coverage for a particular service or treatment, or if the treatment is deemed medically unnecessary.
  • Policy Exclusions: Insurance policies often have exclusions for certain treatments, procedures, or conditions. If a claim falls under one of these exclusions, it may not be covered by the insurance.

What documents do I need to submit when filing a health insurance claim?

Reimbursement – Policy document, valid identity proof, doctor’s prescription/ medical certificate, diagnostic reports, ambulance receipt, original pharmacy bills, medical bills, hospital bills showing breakdown of treatments & relevant expenses, discharge card, First Information Report (FIR), if required.

ClaimDone: Basis these our team supports you in preparation of a document set for your claim which includes the claim form.

Cashless - Claim pre-authorization form-1, valid identity proof and a photograph.

How do I file a claim with my health insurance provider?

How long does it take for a claim to be processed?

Claim processing times vary, but typically take a few weeks. Factors influencing processing time include claim complexity and provider responsiveness.

ClaimDone: We always try to be to speed so that wait time is eliminated due to unnecessary back and forth.

What should I do if my claim is denied?

If your claim is denied, review the denial letter provided by your insurer, contact them to discuss the reason for denial, and consider submitting an appeal with any additional information or documentation that supports your claim.

Are there any limitations or exclusions to my health insurance coverage?

Yes, most health insurance policies have limitations and exclusions. These may include pre-existing conditions, certain treatments, and elective procedures. Review your policy documents or contact your insurer for details.

ClaimDone: We shall highlight these in our assessment part.

Do I need pre-authorization for certain medical procedures or treatments before filing a claim?

Some plans require pre-authorization for specific procedures or treatments to ensure they meet policy requirements. Check your policy or contact your insurer to confirm if pre-authorization is necessary.

Are there any deadlines or time limits for filing a health insurance claim?

Yes, there are usually deadlines for filing claims to avoid denials or delays. Refer to your policy documents or contact your insurer to understand the specific deadlines for filing claims under your coverage.

ClaimDone: Contact us to seek answers to all these complex issues. We are happy to assist to you.

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