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On The Claim
Settlement Process!
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How it works
Book an appointment and talk to our partner
Express your insurance needs, location, lifestyle details, and concerns if any
You consult them on which one you should pick up
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Our partners select a few curated plans for you
Bam! Your lifetime insurance partner does the rest for you!
Cashless:
It’s possible to get a cashless claim if you’re admitted to a networked hospital, an insurance company-affiliated hospital. All medical bills are handled directly by the insurance company for this type of claim. It only takes the payment of the disallowed expenses or non-covered expenses to settle the claim.
Reimbursement
If you file a reimbursement claim, you pay your own medical bills. Once you have recovered, submit all your bills to your insurance company. The insurance company verifies the bills and then reimburses you for the covered medical costs.
This can happen in the following situations :
If you receive treatment at a non-networked hospital
For any reason, you cannot submit a cashless claim
During pre and post-hospitalization expenses, and claims are settled on a reimbursement basis only. However, the insurance marketplaces don’t assist the customers with this.
At OneAssure, we assist you until you receive the claim amount into your bank account.
Types of Claim settlements in Health Insurance
The Claim settlements Process
Cashless Claims:
Locate a networked hospital near you from the website of your insurance company.
You should notify the insurance company or the third-party administrator (TPA) of your claim.
You need to fill out a pre-authorization form for cashless claims, which you can find either at the insurance/TPA desk in the hospital or on the insurance company’s website.
Cashless claims require the following documents:
1)
The pre-authorization claim form.
2)
The policy health card.
3)
KYC documents such as Aadhar and PAN cards of the insured
4)
A doctor's prescription for hospitalization
Pre-authorization forms must be submitted by:
1)
You should submit your hospitalization plan three to four days before your scheduled hospitalization
2)
You must submit it within 24 hours of being hospitalized for emergency treatment.
Locate a networked hospital near you from the website of your insurance company.
A hospital's TPA/insurance department handles the rest of the work.
With a cashless treatment, the initial approval is provided based on the pre-authorization form, after which treatment can begin.
Make sure the hospital sends your bills well in advance so you aren't delayed during discharge. The final approval would be processed by the insurer or TPA based on the documentation the hospital submits at discharge, along with all reports and bills.
As soon as the final claim approval is received, the pending non-payable amount needs to be paid directly to the hospital so that the patient can be discharged.
However, the insurer would provide a reason for rejecting the claim if it is denied. In such a case, you can file a reimbursement claim.
Reimbursement Claims:
If there is a possibility of a claim, inform the TPA or the insurer beforehand.
An insurance company or TPA will require you to complete a claim form and submit the needed documents.
Documents to submit include:
1)
A doctor's prescription for hospitalization
2)
All diagnostic/investigative testing reports
3)
A complete set of records and doctor's reports detailing all the treatments you have received
4)
Original hospital and medical bills
5)
Doctor's prescription stating that you have recovered, and your treatment has been completed
6)
In cases of accidental injury, an FIR or medical certificate is required
7)
Documents such as Aadhar and PAN cards must be submitted by the insured
8)
A canceled check from the bank account, to receive reimbursement of the claim.
9)
Copies of the policy and insurance card.
