Hospitalised? 10 Steps to Win Your Insurance Claim

Getting hospitalised is stressful enough. But a rejected or delayed insurance claim can destroy your savings. Follow these 10 steps from admission to discharge to get your cashless or reimbursement claim settled without drama.

Here's what happened: Cashless health insurance claims are frequently delayed or denied due to incomplete documents or wrong hospital selection at the time of admission.. IRDAI mandates insurers to make cashless authorisation decisions within one hour of receiving a pre-authorisation request from network hospitals.. Millions of Indian policyholders lose valid claims every year simply because they missed procedural steps, not because their treatment was uncovered..

What you should do: Check your insurer's network hospital list BEFORE choosing a hospital — cashless claims only work at empanelled hospitals.. Inform your insurer or TPA within 24 hours of emergency admission and within 48 hours for planned hospitalisation to avoid rejection.. Collect and preserve ALL original documents — discharge summary, pharmacy bills, diagnostic reports, doctor prescriptions — before leaving the hospital..

Always get the pre-authorisation approval number in writing from the TPA. Many claims are disputed later because there is no paper trail of the initial approval.