6 Things to Know About Reimbursement Claims

Times of medical emergencies are difficult to bear. In such a situation, it’s a relief to have health insurance. With the rise in medical cost, such hospitalization situations are financially burdening. 
With health insurance to the rescue, all you want as a policyholder is a smooth and easy health claim process. 

However, the claim process is not a click’s job. With many steps involved, it takes a certain amount of time to process the claim. 

You can go either for a cashless or a reimbursement claim. 

When you get treated from a network hospital, you can avail the cashless claim facility. Whereas, when you go to a hospital that is not in the network of your insurer, your claim type becomes reimbursement.

In this blog, let’s talk about reimbursement claims. 

6 things that are a must know about reimbursement claims

• What it means to go through a reimbursement claim?
  When you get treated in a hospital that is not empanelled or is not a part of the network of your insurance provider, you can’t opt for a cashless claim facility there. Your insurance company directly settles the bill with the hospital in case of a cashless claim. However, in a reimbursement claim, you have to first pay the whole bill amount from your pocket. After properly filing reimbursement with your insurance company, your claim is settled by compensating the bill amount up to what’s covered back in your account.
  
  
• Intimation to Insurance
  To initiate a reimbursement claim, you have to first inform your insurer about hospitalization during the first 24 hours to let them know which hospital you’re getting admitted in along with the treatment reason. Delay in intimation can later pose a problem in claim settlement.
  
  
• Documentation
  There are a lot of documents that have to be submitted in support of your claim. These are proofs and details of your treatment. Documents like hospital bills, discharge summary, lab reports, payment receipt and other supporting documents are required to be submitted for the claim.
  
  
• Investigation and Verification
  Investigation and verification process in reimbursement claims is more rigorous than cashless claims. Since the hospital is not in the network of the insurer, this invites more checks in line to ensure authenticity of the claim.
  
  
• Time Taking Process
  Unlike a cashless process, reimbursement is a much more time taking process. You have to put in all the effort to take care of the entire process even after you are discharged from the hospital. Apart from this, it takes time in investigation as well.
  You have to be patient in case there’s a query from insurance.
  
  
• Pre and Post Reimbursement
  Irrespective of whether the claim is cashless or reimbursement, you can apply for pre and post reimbursement of expenses incurred before and after hospitalization. These are expenses on medicines, lab tests, consultation fee, etc. The time period for which these expenses are covered varies from policy to policy. It could be 30 days before and 60 days after hospitalization or 60 days before and 90 days after hospitalization, etc. This means expenses incurred only during this period are eligible to be covered. You must have supporting documents and payment receipts to attest along with the claim.

Coming to an important point of discussion in reimbursement claims, the major pain point is that despite having a policy, you have to pay the entire bill amount from your own pocket.

We know how stressful it is! 

But ClaimTherapist offers a special service that directly caters to this pain point. 

Medical Loan Facility by ClaimTherapist

Medical Loan Facility is specially offered for reimbursement claims. When you avail this loan facility from ClaimTherapist, you don’t have to pay the entire bill amount upfront. 
Submit the minimum required documents to get the loan process done, pay the non-medical expenses and you’re good to go. 
We will take care of filing and following up for your claim with your insurer. You pay us back only when your insurer reimburses your amount to you.
Oh, the best part - it’s free!

So, the next time you go to a non-network hospital, keep in mind how a reimbursement claim works! 
Also, remember that you have the medical loan option by ClaimTherapist at select hospitals across India.