Mrs. Sindhu was very flustered. She should have been thrilled now that her husband was home after spending weeks in the hospital. But instead, she felt even more exhausted. Trying to file the claim for her husband’s medical health care had left her completely harassed
Wherever she looked, she found receipts, bills and medical reports. They were everywhere! She knew she had to fill in some sort of claim form. And she had no idea which original documents were required for the claim to be processed. Mrs. Sindhu felt very disoriented. But then, just when things were getting really overwhelming, she met a friend who had recently gone through the same situation.
"It’s actually quite simple to file mediclaim in India," said her friend, "as long as you follow the right steps!"
First, put all receipts, bills and medical reports in order.
Arrange them in chronological order.
Check that all the documents contain required information like the patient name, document number, serial number, cost price, signature of the authorised person and so on.
Second, ask your insurance company for the claim form.
Usually the claim form can be downloaded from the insurance company’s website. Read the instructions given in the claim form carefully. Fill in the claim form with all the required details. Make sure the information is correct.
Next, get the claim form signed by the policy holder as well as the treating consultant. It must also be stamped with the official hospital seal.
Finally, attach all the relevant medical and policy documents to the claim form
Medical documents include:
• The discharge summary
• All documents relating to the patient’s illness
• All reports with details of the treatments and procedures conducted
• A certificate from the attending medical practitioner stating that the patient has recovered or is recovering
Policy documents include:
• Details of previous policies
• The starting date of the policy cover document
• The initial details of the first policy
• The Third Party Administrator (TPA) card
Third, prepare copies of all the original documents.
Both, the original documents as well as their copies, need to be submitted with the claim form. Submission of only copies is usually not accepted.
Attach the documents in serialised or chronological order.
Review the documents carefully. Make sure that none of the documents issued at the time of treatment are missing. If any documents are missing at the time of submission, the claim may not go through.
Fourth, submit the documents with the correct TPA.
You can get the name of the TPA from your insurance company. When you visit the TPA branch, ask an executive to check the submitted documents. Then submit the documents with the executive.
You should also inform the health care insurance company that the claim has been submitted, by sending them a set of copied documents.
Mrs. Sindhu did exactly what her friend said, and was able to file her mediclaim policy with ease. What a relief! Now she was free to give her family all her attention!