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Having medical insurance in UAE is one of the best ways to deal with medical emergencies. It ensures a certain sense of security and peace of mind that you have something to fall back on when required. In short, it is important to have a well-suited health insurance policy for you and your family. And, once you have that ideal health insurance plan, you must understand the steps that are involved in filing a medical claim because health insurance is ultimately about that only. With a surge in successful medical procedures and the growth of the healthcare sector, the rate of filed medical insurance claims has also been peaking. Although, with different kinds of health insurance claims, the claim process can be difficult and confusing.
Even with health insurance in hand and the basic claim process as clear as day in front of you, few different complications may arise due to the kind of claim that you need to file. There are 2 basic kinds of health insurance claims – reimbursement claims & cashless claims. Cashless claims are those where insurance providers make the payment of the treatment and medicine claimed for directly to the hospital instead of the insured person who has made the medical insurance claim. On the other hand, the reimbursement claims are paid to the insured for the expenses they incurred on healthcare services in their insurance plan. Reimbursement claims require the insured to cover the hospital expenses and other related expenses on their own first and then later claim them.
Listed following are the steps that you need to follow when filing a health insurance claim for your treatment. There is a separate set of steps for each kind of claim that you file so that you have a clear understanding of the process in every situation:
Not every service, treatment, procedure, and surgery is going to be covered by your medical insurance provider. So, in order to file a health insurance claim, you need to first make sure that the concerned treatment that you are about to file a cashless claim for is indeed covered by the insurer and the hospital that you are getting treated at is in the network. Check the terms of the policy and find out the extent of the services that the insurance company covers. This is the best possible thing to do to avoid claim denials and rejections especially in the face of a medical emergency.
As soon as you have verified all the information that you would need in order to make sure that the hospital and the treatment you are about to take are covered by the provider, make a call to the company. Inform them of the cashless health insurance claim that you need to make so that they are aware of the situation and can verify everything on a second level. As soon as you reach the hospital, you are generally asked to fill out a bunch of forms. One of these forms will be a pre-authorization form and one would be a third-party Admission form. The hospital will forward both these forms to the insurance company for approval of the cashless health insurance claim that you made.
In addition to identity proofs, and KYC documents, you will have to submit the card provided by your insurance company for availing of the cashless services. All the required documents are to be submitted on the third-party admission counter of the hospital. The person in charge of the documentation will let you know if there are any additional documents required to be submitted so, don’t hesitate to verify.
It is always best to keep a copy of the records with yourself in case any discrepancies arise in the future. While the original documents will be either kept by the insurer or the hospital, for the time being, make sure you get a copy of everything and keep it safely with you.
Several post-hospitalization services are also covered in health insurance claims. Make sure that you have kept all the bills and expense receipts with you safely if these services are not covered under the cashless medical insurance claim of your plans. This also includes prescription medicines and other similar expenses. The bills will be required for you to make a reimbursement claim, which can be filed later. Also, once again check the terms of the insurance plan before you file a claim so that there is no scope for denials and rejections. The steps that are required to be followed for a reimbursement claim are given as follows.
As soon as you have decided to file a reimbursement health insurance claim, inform your insurance company so that you can get to know the deadlines if there are any. The general rule states that reimbursement claims need to be filed within 30-120 days of the discharge or the service used. So, ensure that you have all the info to get started on the health insurance claim process beforehand.
The next comes the paperwork. A reimbursement claim generally takes a bit more paperwork as compared to that of cashless claims. You will need a duly filled reimbursement application form, which can be either obtained from your broker or the online portal of the insurance provider. With them, you will have to attach all the medical bills and receipts for which you are making the claim – signed and dated by the person in charge. The bills should also mention the hospital clearly with their registration number so that network hospitals can be identified, not to mention the name of the patient as well. A prescription mentioning hospitalization/procedure/surgery/medication as a mandatory action for your condition should also be there from the doctor assigned to you. You can also take help from the online claim portal of your insurer. The portals generally have a link that contains a list of documents required or a pdf format file with the information.
Once you have collected all the documents that you need and have filled the claim form, submit them to the insurance company through your insurance agent or via the online portal. Another thing that you will be required to submit is a set of discharge documents or the discharge card that the hospital issues after you have been cleared for all the treatments and procedures.
Once you have submitted all the documents, the insurance company will start the investigation and review process for your medical insurance claim submission and process everything. Be on your toes during this time and keep a lookout for any emails/calls/text messages from your insurance company. There could be a chance that your claim is rejected due to a clerical error in your application or because a certain document is missing. If you receive such a rejection email, recheck everything and submit it in time because there is a deadline for this procedure as well.
The final step of settlement generally takes about two or three weeks. During this time, makes sure that you have kept the copies of every document submitted or required as per the documentation process suggests. Once you have received the final settlement amount, your medical insurance claim process will come to a close.
Taking on a health insurance policy is not something you will face many challenges with. However, your job does not end there. The success of your health insurance in UAE or anywhere else for that matter depends on the success rate of the claim process. If you can successfully file a health insurance claim and get the settlement reimbursement that you seek, only then taking on health insurance would be a successful decision that you took. Although, with all the aforementioned steps in mind, there is very little chance that you will face a denied or rejected claim for your medical insurance in UAE unless there is a discrepancy in the paperwork or terms. But, when all is said and done, the claim process is a fairly easy procedure if you have traced all the important steps ideally.