Is there a claim settlement deadline for health insurance claims?


#1

Is there a claim settlement deadline for health insurance claims?


#2

Yes all health insurance companies need to settle all duly filled claims within a stipulated period of 30 days. If the insurance company is unable to process your claims within 30 days of receipt of all required documents and claim form, the policy holder has the legal right to seek interest in the claim amount for the delayed period.


#3

Hi Reba,

Usually, Health Insurance claims are settled within 30 days. The process for cashless claim will differ from one insurance company to another. However, we can tell you the generic procedure that most insurance companies follow. There are 2 kinds of hospitalisation – one is planned hospitalisation and the other is emergency hospitalisation. In case of planned hospitalisation, insurance firms require you to inform them well in advance if you are opting for a cashless claim. You need to fill a cashless request form that might be available on your insurance firm’s website. You might need to scan and attach relevant documents.

Once you submit the form, the insurance company as well as the hospital (where you plan to go) will verify the claim. You might also need to fill a form at the hospital. Once you have your discharge summary and it is sent to the insurance company, the company will settle the claim with the hospital. Most insurance firms revert within a day or two if all documents are complete. In case of emergency hospitalisation, you will have to fill forms at the hospital and inform your insurance company’s customer care that you will be getting hospitalised. Most insurance firms either accept or reject your claim within 6-8 hours. Even though there are firms that claim that they can do it within 4 hours, it may take longer than that. Once you get your discharge summary, the insurance firm will settle the claim with the hospital.

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Cheers,
BB Expert