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A Definitive Guide to Health Insurance Claims


While entering a hospital for care, the last thing you want to have to worry about is how to pay for the treatment… especially when you’re already covered by health insurance! Unfortunately, if you’re not prepared, the avalanche of claims-related paperwork and processes can drain your energy and strain your patience.

As the experts in hospital insurance claims management, we at Attune would love to share some insights.

Step 1: Read Your Policy… As Soon As You Receive It

This can seem a daunting task in itself, as many of these policies extend to dozens of pages in length! However, it’s essential that you read and understand your policy well in advance of any requirement you face to actually make an insurance claim.

This way, you know:

  1. What is covered. Are you insured for outpatient procedures? What about tests? Is domiciliary support covered? Pregnancy?
  2. Where to go. A tight network of hospitals will allow cashless claims against your insurance policy. Identify which those hospitals are and which is the closest, so that you are prepared in an emergency.
  3. Who is insured. Ideally, you should know this one already! However, it never hurts to confirm just who all are listed on the policy as dependents.

Step 2: Learn the Terminology

There’s a lot of jargon when it comes to the world of insurance claims. TPA (Third-Party Administrator). Network Hospital. Cashless Claims. Dependents. Pre-existing Conditions. And that’s not even considering the medical terms!

When you come across a term that doesn’t make sense, don’t just assume you know what it means. Google it – or drop us a message at our Facebook page and our team will get back to you.

Step 3: Get Organised

Consult with the TPA representative or the hospital insurance desk to create a comprehensive list of documents to be submitted, in hard copy or digital format. Go through the list. Do you have them all with you? Make a list of all the documents you need from home and try to make a single trip to collect them all.

A number of documents needed for the Claim Submission will be provided by the Hospital during the course of treatment – prescriptions, invoices, bills from pharmacy, requisitions, and more. Maintain a file to keep all these documents in one place.

Step 4: Have Patience

Don’t rush your insurance claim submission. When faced with the prospect of spending time on paperwork or with your hospitalised loved one, few will choose the former. And yet, it’s better to invest the extra hours ensuring that the claim is filed correctly, than to go through the shock and distress of a rejected claim.

Once you have submitted your claim, follow up regularly – but be patient. Losing your cool or damaging your own health will not help speed up the process!

When it comes to handling hospital insurance claims, remember: don’t panic. The claims process can seem long and painful, but if you follow these four simple steps, you can easily and efficiently get the claim processed. Keep calm and take care of yourself and your loved ones. Reach out to the hospital, your insurance agency or TPA for assistance when you need it. Remember… you don’t need to do it all by yourself!

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