TATA AIG Health Insurance Claim
An insured can either go for cashless treatment in the network hospital of TATA AIG General Insurance Company or can opt for reimbursement of all the medical expenses incurred. The stepwise procedures of both the methods are given below:
Claim Process – Cashless Planned/ Emergency Hospitalization:
In the cashless procedure, an insured need not to settle the medical bills of hospitalization instead the insurance company directly deals with the hospital. However, the hospital in which the insured is hospitalized or taking treatment must be in the list of network hospitals of TATA AIG. This hospitalization can be planned or be an emergency. There will be a Third-Party Administrator (TPA) cell in the network hospital to represent TATA AIG. The TPA coordinates with the hospital in order to settle the claim. The steps for the same are:
- The insured needs to inform the TPA of the TATA AIG for the hospitalization. In case of planned hospitalization, the insured must inform the TPA at least 48 hours before the hospitalization. If it is an emergency hospitalization, the insured or his/her family member must inform the TPA within 24 hours of hospitalization.
- The TPA of TATA AIG can be contacted through any of the following numbers 1800-425-4033 and for senior citizens at 1800-22-9966.
- The insured or his/her attendant is then required to fill the claim form and give it to the TPA cell along with all the required documents.
- The TPA then reviews these documents and forwards them to the insurance company.
- The insurer scrutinizes all these documents and the confirmation is sent to the hospital either by fax or email.
- After completion of the formalities, the policyholder will become eligible to get cashless treatment as per the terms and conditions of the policy.
- Finally, the medical bills for hospitalization will be settled between the insurance company and hospital as per the policy’s terms and conditions.
Claim Process – Reimbursement:
TATA AIG health insurance policyholder is eligible to get the reimbursement of the healthcare treatment at the hospital, if his/her cashless claim is not approved or if he/she is not taking the treatment in the network hospital of TATA AIG. An insured must follow the steps mentioned below to file reimbursement of the treatment expenses:
- The insured has to contact the TATA AIG General Insurance Company within one week after discharge. For the same contact the TPA at 1800-11-9966 or 1800-266-7780.
- Duly fill the claim form and attach all the relevant documents with it.
- Send these documents to TPA and the TPA will forward them to the insurance company.
- The claim processing team of the insurance provider will review all these documents and may ask for additional documents if needed.
- The status of the claim (rejected or approved) will be communicated to the policyholder.
- In case of approval, the claim will be settled according to the terms and conditions of the policy.
- The approved amount will then be reimbursed in the account of the insured.
The following documents are required in case of filing claim for reimbursement for treatment:
- Filled claim form
- Attending doctor’s report
- Discharge summary issued by the hospital
- Bills of the prescriptions
- Pathology reports, if required