The insurance claim form is something most people are not familiar with. It's natural therefore that when the time comes for one to fill a claim form, they are bound to face difficulties. To begin with, one is already facing the pressure of hospitalization and treatment bills, and to then fill a form which will help you get this money, the pressure only grows. This is because the insurance claim form is not designed to be very user-friendly. Many people spend days struggling to fill that form.

Things To Watch Out

You don't need to lose your sleep over it if you take care of these 4 aspects.

1. ID Numbers

Insurers need to tag your claim to the right customer and the only way to do so is by identifying the customer by their ID number. The problem comes when claimants enter wrong ID numbers. And why does that happen? People have multiple insurance cards collected over multiple years, so there is a common mistake of entering previous year's insurance card number in place of current year number. Another frequent problem especially with corporate employees is that they tend to mention their employee ID in place of insurance ID, and forget to link the form to their corporate name. There is no field in the form to capture company name. So the insurance ID only has to be entered.

How to fix this?

Make sure the card or policy belongs to the period for which claim is being filed
If you are mentioning your employee ID, then remember to write corporate name somewhere on the claim form where is it visible. But this is a risky way to claim. Always prefer to mention insurance ID
Call insurance company and use the IDs available in your policy or insurance card. If the call centre people are able to successfully identify the patient with the ID numbers you present to them, you can be sure that ID works. Else, check with SureClaim expert, your agent or HR to get clarity on ID number.

2. Treatment category

As per standard health insurance claim form, treatments taken at the hospital are classified as illness, injury or maternity. Now the last one is self-explanatory. The problem comes with the other two. If it's an illness case, it includes medical management cases, day-care procedures as well as surgeries. The supporting documents required for each of this sub-category is different. Same goes for injury sub-category. Self-fall, accidents due to drunken driving, injuries due to an assault, poisoning cases etc all come under injury. It's because the patient was not sick, his hospitalization is due to an adverse event. And therefore, the next question which arises is, whether police was involved in the case or not (FIR filed or not), or did hospital register case as a medico-legal case. The claimant is required to provide sufficient documentary proof to support a claim in this sub-category.

3. Claim Amount

Many people make the mistake of claiming an amount which doesn't match their bill value. This happens because there could be discounts which are not highlighted in the bill, or they're only trying to claim some part of the bill. Ideally, one should list down bills they want to claim and add up the bill value. The claim amount must match the aggregate bill value. Necessary proof or supporting documents must be submitted as evidence for those bills. Wherever possible, payment receipts should be submitted totally with the bill amount, or a proper justification from the hospital should be documented when bill and receipt amounts differ.

4. Bank details

Claim is almost always in the name of the primary policyholder. In case of individual retail policies, it's the proposer in the policy who is a primary policyholder. This primary policyholder may not himself be covered in the policy. On a similar note, in corporate policy, the employee is a primary policyholder, or primary insured. The reimbursement in the claim will always come into primary policy holder's account. Many people tend to mention patient's bank account details and this person may not be a primary policyholder. This leads to unnecessary delay in claim because insurance company will raise query that the bank account holder name is not matching with primary policy holder. Sometimes, when everything is correctly filled, there may still be issues because claimant's name in policy and bank details may not entirely match. Take precautions as per these 4 points and we are sure your claim will be a breeze. You can also consult a SureClaim expert online to get all your doubts sorted or even get your claim prepared by a professional to reduce chances of errors. After all, you need your money back as early as possible.

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Author Bio

Anuj co-founded SureClaim to fix the broken claim experience of insurance customers. He believes technology can play a major role in empowering customers. His understanding is shaped by his decade long stint in healthcare and health-tech companies