Cashless Hospitals Network:
It has been observed that, many of the Health Insurance claims are repudiated due to deficiency in required claim documents. Insured/ Customer should have due diligence for below mentioned documents for valid health insurance claim:
The documents are to be submitted to insurance desktop of a network hospital for cashless claim or Insurance Company or TPA for reimbursement claim.
- a) Inform / intimate insurance company or TPA or us as soon as insured is hospitalized or decides to go for it.
- b) Minimum 24 hours hospitalization is necessary for all the treatments except the treatments included in the list of Day care or Domiciliary treatments.
- c) Please check on website of TPA or insurance company that the concerned hospital is blacklisted or not.
- d) Concerned hospital must be registered as Hospital by local authority.
- e) Concerned hospital must have minimum 10 beds for small towns & 15 beds for large cities.
- f) Submit duly filled claim form with medical section filled up by treating doctor.
- g) Provide clear copy of insurance policies of last 4 years.
- h) Provide clear copy of Government ID like Aadhar card or Pan Card etc. containing clear birth date of the claimant.
- i) Provide first consultation paper, pre hospitalization consultations, discharge summary with medical history, receipt of Operation & Operation theatre charges, receipt of Anaesthetist, fees of Surgeon, visiting charges, IPD treatment papers, advice for Investigation reports, medical reports, prescriptions & bills of all medicines (even for repeated) in synchronization with quantities in bills of medicines.
- j) All the above mentioned documents must be endorsed by treating doctor with seal.
- k) Original Cheque of bank account of Insured or main proposer is to be provided in case of reimbursement claim.
- l) Retain a copy of claim fie for whole life.
- m) Same procedure is applicable for a post hospitalization claim to be logged within stipulated number of days like 60 or 90 days after discharge from hospital. The number of such days varies from company to company.