The Policy Bazaar Show is a brand- new series that decodes the grey areas of purchasing insurance. Through the 26-episode series, the show will highlight and discuss a magnitude of topics essential to everyone trying to secure their future. From purchasing the right cover, to switching policies while shifting jobs, to ensuring a comprehensive child cover, insurance experts deliberate, simplify and shine light on the complexities of purchasing insurance in India.
In this week’s episode, our eminent anchor Vivek Law talks about the claim settlement process of health insurance with Amit Chhabra, Business Head, Health Insurance, policybazaar.com and Manish Dodeja, Executive Vice President, Claims, Religare Health Insurance.
The smooth claim settlement process becomes a benchmark for a good insurance company. Hence, it should be a simple process, even more so than the buying process. There are two basic modes of claim settlement, which are cashless claims and reimbursements. The reimbursements become a more preferred mode during emergencies, and they are usually taken when the hospital is not under the insurance company’s cashless network. The process of reimbursement starts with the submission of all documents (diagnostic reports, reports of hospitalization, reports received during the discharge). The hospital and insurer then take the process and reimburse the amount.
The cashless claim mode, however, works with pre-planned surgeries or treatment of long-standing illnesses. In case of a cashless claim, intimating the insurer helps in speeding up the backend process. The documents along with the intimation are to be sent to the insurer in case of a pre-planned hospitalization. The documents should also have an explanation of the need for surgery or the treatment. The policyholder, then must submit the cashless health insurance card to the hospital so that the hospital can co-ordinate with the insurer about the stipulated amount and the payment. Technology has further enabled simplification of the claim process.
Insurance companies can refuse claim unfairly
With standardizations and recommendations by the Insurance Regulator, the insurer does not usually refuse claims, but in case of an unfair refusal, the consumer can represent a case before the insurance company or formally file a grievance with the company. The insurance company is bound to come back with a decision within 15 days. Consumers can contact insurance ombudsmen bodies as well.
Watch to know more about the claim settlement process from the experts.