How to claim health insurance during emergencies

Medical emergencies are emotionally taxing, but with a good health insurance plan, at least the financial aspect can be protected. However, the ease with which you can make a health insurance claim is crucial as you might not be in a position to figure out the exact claim procedure when the emergency hits you. Therefore, keeping prior knowledge always becomes a help during emergencies. Read on to learn more about how to claim health insurance during emergencies.

How to claim health insurance without any complications?

When a medical emergency occurs, the first thing you need to do is not panic. Contact the nearest hospital with emergency care, book an ambulance and transport your patient there. Once your patient is under the medical supervision of a registered practitioner, you can fret about the claim.

Before starting an emergency health insurance claim, ensure you are aware of the network hospitals where you can take your patient without having to fret about the medical bills. If the hospital of your choice is empanelled with your insurer, all you need to do is provide a copy of your health card or policy document and the patient’s KYC documents, i.e. identity proof (PAN Card will do) to admit him in the emergency ward.

Ideally, for planned hospitalisation, you need to inform your insurer at least 3-4 days before hospitalisation to authorise a cashless claim. However, for emergency hospitalisation, you can do so within 24 hours of hospitalisation. You need to submit the duly filled pre-authorisation form along with the insured person’s identity proof and health card of your valid health insurance policy at the TPA or insurance desk of the hospital. Once the hospital receives the initial approval from the insurer, you can continue the treatment of your patient in a cashless manner.

At the time of discharge, the hospital would send the final bill to the insurer for approval. Most parts of the bill should be settled directly by the insurer, but the portion that is not payable, such as consumables, co-payment, if any, etc., must be paid by you at discharge.

However, if you opt for a non-network hospital, you need to make a payment upfront and then provide all original bills and receipts to the insurer to file a reimbursement claim. However, remember to inform your insurer about the hospitalisation within 7-15 days of admission as per the policy’s timelines mentioned.

How to keep prepared for a possible medical emergency?

Here are some tips to keep yourself and your family prepared for a possible medical emergency:

1. Know the details about the health insurance policy.

Keep the health cards handy. Know the insurer’s toll-free number and email id so that you inform the insurer of the possible health insurance claim and register the same.

2. Network of hospitals:

Keep yourself and your family aware of the updated list of the network of hospitals with your insurer, wherein you can avail of a cashless hospitalisation without having to pay anything upfront. This is a piece of essential information, and make sure all members of the family are aware so that they are fully equipped to handle any medical emergency without your assistance.

3. Medical records:

Keep a record or an archive of your family’s medical history, current and past ailments, and the regular medicines that you or anyone in your family takes so that it can be informed to the doctor at the hospital in case of emergency hospitalisation. If only the concerned person is aware, others may not be able to provide accurate information to the doctor for correct diagnosis and treatment. So, having an online medical archive could come to your rescue.

Conclusion

Emergency health insurance claim is one of the most important reasons for availing of a health insurance plan. So, keeping yourself and your family updated about the process will not only help you ease the process but also give you the confidence to proceed with the claim without having to take help.

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