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Health insurance claims procedures are very specific for different scenarios, such as emergency or planned hospitalization. To 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 admission.

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).

Health Insurance Claims: Basics

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