With the recent ongoing pandemic issue having health insurance to cover medical needs for you and your loved ones is essential. No matter if you are planning to buy the best health insurance or have one already, it is important to remember some basic points that can help in a successful claim settlement.
At the time of hospitalization, your
efforts should be to take of your loved ones but not worry about financial
help. Whether you have a family
health insurance plan or an individual health insurance plan, a minimum
expectation would be a hassle-free claim settlement. Most times the health
insurance claim gets cleared if all goes well, but rarely there can be some
cases that get rejected or delayed. Let’s try to explore some possible reasons that
can delay the health insurance claim process.
Late Submission of Claim Filing
One of the main reasons for the delay or
rejection of the claim of health insurance can be not submitting your claim
request on time. Guidelines and deadlines for claim form submission would be
mentioned in the policy document. The deadline for claim application can vary
from company to company.
Most people ignore reading the policy
document properly which can lead to mistakes later at the time of the claim
process. Hence you must apply the claim request within the stipulated time for quick
and successful claim settlement. In case you forgot to submit it on time or got
delayed for some reason then you can expect a delay in the process.
Not Having the Insurance Papers
Your health insurance document is basic
proof that you have the coverage from the insurer and have a certain amount of
cover. You must preserve that safely and handy at the time of hospitalization.
Saving a soft copy backup of the health insurance papers that can be accessed
anytime is a good idea. If the health insurance papers are not readily
available at the time of claim application and if you find them later then
there will be a significant delay in the claim process too.
Not Following Pre-authorization
Process
Pre-authorization is the declaration done
by your insurer if you are going to have a planned hospitalization for
pre-planned treatment. To get the cashless treatment you must inform your
insurer about your planned hospitalization in advance at least before 48 hours.
For most of the insurance companies, the pre-authorization process flow is generally
as mentioned below.
- Get the pre-authorization form
from the insurer or TPA desk at the hospital
- Fill the form with accurate
details such as patient details and insurance details
- The treating doctor may need to
fill in the details about the medical procedures conducted to treat the insured
person
- This form is then sent to the billing
desk in the hospital for the estimation of the treatment cost and other costs
that may be incurred in the treatment
- The pre-authorization form is
then shared with the insurance company along with required documents
- The final step is the insurance the company verifies the submitted pre-authorization form and attached documents
and sanctions the claim
- Any delay at any of these steps or errors can lead to a delay in the claim process. That is why you need to make sure there are no manual errors that are under your control at least.
Delay in Communication between the
Hospital and the Insurance Company
Any delay in communication between the
hospital and the insurance provider can lead to a delay in the claim settlement
process. The hospital has to send your discharge summary report and all billing
details. Claim settlement can delay if there is a delay in receiving the final
document from the hospital.
Mistakes in supportive
information provided by the insured
Another issue behind the delay in the claim
settlement process may be due to errors from the customer end. Errors in
filling form such as entering the patient details or policy details wrongly can
be one reason, in which the insurance company would ask for the correction. Another the reason may be the wrong entry of discharge date and time, not notifying the TPA
to prepare the necessary documents and share the same with the insurer, not
able to provide the required supporting document on time.
Conclusion
Most of the time the reason for the delay
in the claim may due to errors in filling claim form. Such manual errors can be
avoided if the insured person is aware of the policy wordings. Another type of
error can be communication delays or errors in entering the billing details or
wrong entry of treatment details. The insured person should take care to
minimize the possible errors by spending time to understand the policy
wordings, terms, and conditions. Once you know the in and out of your policy
there is less chance of errors from your end.