Claim Intimation in Health Insurance

What is Claim Intimation in Health Insurance?

Claim intimation is the process where the insured notifies the health insurance company that they need to use their health insurance. The insured must timely inform about a hospitalization before or after their treatment, depending on whether it is a cashless or reimbursement claim.

It is the first step of the health insurance claim process through which the insurer gets to know about the insured’s willingness to avail policy coverage or benefit.

Why is Health Insurance Claim Intimation Important?

Failing to timely initiate a claim can lead to claim delay or even rejection. In fact, it is one of the most common reasons for health insurance claim rejection. Without this step, the insurer would not know or have any record of your medical treatment. Hence, missing this step means missing out on the health insurance coverage when you need it the most.

When to Intimate a Claim in Health Insurance?

To avail health insurance benefits, you must make a claim intimation:

• Within 24 hours in case of a medical emergency
• At least 48 or 72 hours before the planned hospital admission

To avail the ‘Cashless Anywhere’ facility, a claim intimation must be made within 48 hours of hospitalization in case of emergency or 48 hours before admission for a planned treatment.

Disclaimer: Claim timelines may vary across insurers. Always check with your insurer for timely intimation.

What Details Should You Tell During a Claim Intimation?

Usually, the following details are required when a claim intimation is made:

• Policy number
• Policyholder or insured’s name
• Hospital where the insured is admitted
• Health card number (in case of cashless claims)
• Reason for hospitalization
• Summary of treatment
• Date and time of admission
• Contact information

How to Intimate a Claim in Health Insurance?

You can initiate a health insurance claim through:

• Insurer’s website or app
• Insurer’s toll free number
• Policybazaar.com

Here is how you can initiate a claim in a few simple steps:

• Inform the health insurance company that you want to raise a claim.
• Share your policy number, hospital name, reason for hospitalization and date of admission.
• Submit the pre-authorization form for cashless health insurance.
• Collect required medical documents and bills in case of a reimbursement claim.
• Follow up and wait for the insurer’s final claim decision.

Claim Intimation: Cashless vs Reimbursement Claims

For a cashless claim, pre-authorization is required so that the insurer can directly settle the medical bill with the hospital. In case of a reimbursement health insurance claim, you must first pay upfront, after which the insurer reimburses the approved amount. However, in both cases, early intimation is required.

Claim Intimation in Cashless Health Insurance Claims

• It is done at network hospitals.
• You must carry your health insurance card and identification proof (like an Aadhaar card).
• The hospital coordinates with the insurer to get pre-authorization for cashless treatment.

Claim Intimation in Reimbursement Health Insurance Claims

• Inform the insurer about hospitalization or treatment.
• You must pay medical bills out of pocket, as and when required.
• Submit the documents when the treatment is completed.
• The insurer will then verify and process your claim.

What Happens After a Health Insurance Claim is Initiated?

Initiating a health insurance claim means that the insurer or the third-party administrator (TPA) has registered your case. The insurer then starts processing your claim request.

• You will receive a claim reference number that is used to identify and further track your claim request.
• The insurer or TPA reviews the claim form and verifies policy & coverage details.
• They check discharge summary, medical bills, policy exclusions, co-payments or deductibles clauses, sub-limits, etc.
• Claim investigations may happen if there are any discrepancies or if medical bills are unusually high.
• The insurer accepts or rejects the claim request and informs you of the claim decision.

Common Mistakes to Avoid When Initiating a Health Insurance Claim

Here are some of the common mistakes that people often make when contacting the insurer about a health insurance claim:

• Delaying claim intimation beyond the allowed timeline.
• Not knowing the right TPA.
• Not having important details like policy number, health insurance card, etc. handy.
• Mentioning incomplete or incorrect hospitalization reasons or treatment.
• Not noting the claim reference number.
• Not checking the network hospital status.
• Assuming the hospital will take care of the claim process.
• Not knowing the expected timeline for the claim decision.
• Not keeping a record of original hospital bills and payment invoices.

How to Make Claim Intimation Easy?

To ensure a smoother health insurance claim intimation process, you should:

• Have the mobile app of the insurer or aggregator (like Policybazaar.com) from whom you have bought health insurance so that you can easily raise a claim with a single tap.
• Ensure that you know whom to reach out to: health insurance company, aggregator or TPA.
• Share the policy details with your family so everyone has the information needed to initiate a claim.
• Always keep a policy copy handy, whether in physical form or saved on your phone.
• Always note the claim reference number.
• Most importantly, always intimate at the earliest, even if you are unsure or it is an emergency situation.

Final Verdict

Claim intimation is the first step of the health insurance claim process, and you must inform the insurance company as soon as possible to avoid claim rejection or delay. Following this one simple step can help you to make your entire claim process smoother.

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