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A health insurance claim is the process by which a policyholder (you) requests financial benefits and other related services covered by their policy from their insurance provider (us).
Let’s understand it in simple words!Â
When you need money to pay for treatment for any major or minor illnesses or any other medical condition covered by your health insurance plan, you can file a claim.
You have to provide all information about the medical costs and the necessary paperwork to approve the claim. Once the claim is made, the insurance company reviews and authorizes it.
A health insurance plan's only objective is to provide financial support to you in times of emergency. To receive this financial assistance, you must file a claim.
There are two types of medical claims that a policyholder can file:
Let’s understand both types of claims in detail.
A cashless claim is a type of health insurance claim where you can get treated at a network hospital without paying out of your own pocket. Instead, the costs are sent directly from the hospital and settled by the insurer.
So, to get a cashless claim, you can head to one of your insurer’s network hospitals and show them your health e-card and ID proof.
Remember that you need to get your claim approved by your health insurer:
Then, you can get all your treatments done and share the required claims forms with the Third-Party Administrator (a mediator between the hospital and your health insurer). And that’s it. The insurer will take care of your claims.
The second type of health insurance claim are reimbursement claims. In this type of claim, you can visit any hospital, not just those under your insurer’s cashless network. Here, you get your treatment done at the hospital, pay out of your pocket, and then apply for reimbursement for the expenses with your insurer.
When making the claim, you must submit all your hospital bills, prescriptions, medical documents, and other important documents. These will need to be approved before your claim is processed, meaning it can take slightly longer to get through.
Here’s a quick table to help you understand the key differences between the two main types of health insurance claims – cashless and reimbursement:
You can submit a claim against your policy online or in writing to your policyholder to recover your hospitalization expenses. For example, if you have taken Digit’s Health Insurance, here are the steps to get a cashless and reimbursement claim.
Step 1: Choose any 8400+ Network Hospitals at Digit for a cashless claim.
Step 2: Notify us within 24 hours of being admitted to the hospital in case of an emergency or at least two to three days before any scheduled hospitalization.
Step 3: Present your e-health card to the hospital's help desk or insurance support desk and get the pre-approval paperwork.
Step 4: Complete the form, sign it, and turn it in at the support desk.
Step 5: If everything is verified, you can proceed with the treatment using the cashless facility.
Step 1: Call us within two days after being admitted to the hospital.Â
Step 2: You will receive a link to upload soft copies of all original documents (bills, reports, etc.) along with the bank account information of your choice.
Step 3: You must personally sign each document before uploading.Â
Step 4: Upload the documents after you obtain the link or within 30 days of the discharge date.
Step 5: You will be paid within 30 days after verification and approval of the document.
Health insurance claims are the backbone of any health insurance policy, offering financial support when needed. Digit Health Insurance provides two major claims types: cashless and reimbursement.
Let's understand the different types of claims offered by Digit:
Under the cashless claims option, all expenses incurred at a network hospital are directly settled between the hospital and the insurer. This ensures that policyholders do not have to pay out of pocket at the time of hospitalization, except for exclusions or deductibles outlined in the policy.
However, if a cashless claim is not processed for any reason, policyholders can switch to a reimbursement claim.
Reimbursement claims come into play when treatment is availed at a non-network hospital or if a cashless claim cannot be processed. Digit offers the following types of reimbursement claims:
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