Proactiv Renewing
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Proactiv Renewing
Be Proactive for a Smooth Claim Settlement
It’s been six months since Mr. Sharma, had been discharged after being hospitalized, and he is still struggling to get his claims reimbursed. It’s not that his hospitalization claim is not valid, it is the fact that each time in this time period, he has sent incomplete documents to the TPA, which has lingered the entire process and kept him waiting.
If Mr. Sharma’s example scares you, and you do not wish to be in his place while making claims, ensure you have everything ready and do not have to face rejection of your claim by the insurance company.
So what are the things you must keep in mind? Here you go:
- Dates and deadlines:
First thing first, it is important to know your dates and not goof up, else you can end up unpaid! All reimbursement claims MUST be submitted within 30 days from the date of discharge from Hospital. This should also include all the related OPD expenses upto 30 days prior to date of Admission in Hospital. For Post-Hospitalization expenses (all related expenses upto 60 days from Date of discharge), you can submit the bills within 90 days from Date of Discharge from Hospital.
- Original documents:
Don’t forget you need to submit original documents, hence keep them safe.
- Basic documents include:
1. Discharge Card
This is a very important card that contains basic details including, date of admission and discharge, patient’s condition while getting hospitalized, brief diagnosis and treatment administered at hospital and doctor’s advice on discharge.
2. Letter of 1st Consultation and advice for hospitalization
This is the document which your doctor gives you in writing on his letterhead, mentioning if, and why you need to get hospitalized for medical treatment of a disease and if a surgery is essential. The correct date should be mentioned on the letterhead.
3. Hospital Bills with Receipts Duly Stamped and Signed
Bills and receipts are proofs on the basis of which payments will be made to you. The bill should be detailed. In case, a standard pre-printed receipt is not available and the same is furnished on a hospital letterhead, a stamp is must. Also insist that the Registration No. of the hospital is mentioned on the bill.
4. Medicine Bills with doctor’s prescriptions for the same
Each medicine bill must have a date on it and should bear the patient’s name too. Also, these bills, if accompanied by the doctor’s prescription, give authenticity to your claim.
5. Medical reports, bill receipts and doctor’s Letter for all tests performed.
All the tests that you undergo, must be advised to you by your doctor and documented by way of doctor’s letter/s. A receipt of payment should be produced and the medical report should be submitted. Also, the X-Ray films must be ready as the TPA has a right to call for X-ray films.
6. Consultation Receipts
This is the proof of payment made to the doctor in exchange of his consultation. As these payments are small in denominations, you may often forget to get these receipts. But not getting them means losing out on payments. The best thing to do is to insist on getting a receipt, each time you visit the doctor for consultation.
To read more about Be Proactive for a Smooth Claim Settlement
About the Author
Medimanage Health Insurance India
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