Health insurance claims procedures are
very specific for different scenarios, such as emergency or planned
avail inpatient hospitalization services, you can go to any hospital of your
choice, either at a hospital on the insurer's network or even outside the
network. The difference is at a network hospital, the Third Party Administrator
(TPA) can authorize cashless service at a network hospital whereas you will
have to settle all the bills at the hospital which is outside their network.
Cashless service is the service where you
need not pay any amounts either as a deposit at the time of admission or for
the hospital bills at the time of discharge. This facility is available only at
the insurer's network hospitals. To avail this cashless service, you fill the
cashless request form available at the network hospital and get an
authorization from the TPA. This authorization along with a copy of the card
issued by the TPA has to be given to the network hospital at the time of
The general procedure for a health insurance claim includes informing the TPA about the hospitalization and then submitting the claims form. The TPA would then reimburse your expenses or settle with the hospital (if you have availed of the cashless facility at a network hospital).