Insurance Claim Settlement Process

Insurance begins with the purchase of a policy and ends with the successful processing of the claim. It is a prepaid service where the insurer or the insurance company promises to provide cover for the Insured or the client during previously agreed-upon eventualities. A good insurance company is one that promptly accepts claims and quickly processes them.

In this blog, we try to explain the claim settlement processes of some common Insurance plans.

CLAIM SETTLEMENT OF INDIAN HEALTH INSURANCE PLANS

The insurance industry in India is process-driven rather than customer-driven. The strict rules and guidelines set by statutory authorities require insurance companies to seek sufficient and accurate details from the clients to process their claims. On their part, insurance companies follow the process with zeal to avoid being duped by unscrupulous clients who make false insurance claims. This is an undesirable but unavoidable inconvenience that clients have to face while getting their claims settled.

Barring emergency hospitalization, most Mediclaim and international health insurance for students provide a cashless facility i.e. payment is made directly to the hospital by the company. Insurance agencies first ask clients to submit valid medical documents in order to accept their claims. These documents include Medical bills, Payment receipts, and Insurance ID cards among others.

These days, most hospitals make a file for every patient who is admitted or is undergoing treatment at the hospital. On request, some hospitals even prepare a separate file with all the relevant documents that a patient might need to make a claim with his or her insurance service provider.

Some health insurance plans also include coverage against critical illnesses. These require the clients to report to the insurance company once such illness is detected. This helps in the timely processing of the claim. They include diseases like cancer and illness due to kidney failure. In such cases, patients must keep copies of diagnosis reports, X-rays, and doctor’s examination reports as well as recommendations for surgery (if any). Once the illness is detected, they should immediately contact the insurance company and send them a copy of the above-mentioned reports, if asked.

CLAIM SETTLEMENT OF STUDENT INSURANCE FROM INDIA

In the case of those students going abroad who have purchased health insurance from an Indian company, they should ensure that the claim processing record of that company is smooth and transparent. Student Cover plans provide comprehensive insurance coverage with an easy processing facility and a 24×7 claim support system for such students. Students going to the United States for higher education are advised to visit our Insurance Process webpage to learn more about using insurance policies and making insurance claims through the Internet or on the phone.

CLAIM SETTLEMENT OF STUDENT INSURANCE FROM THE U.S.

The US Health Insurance industry, unlike its Indian counterpart, follows a customer-centric approach to processing and settling claims. It aims to not only provide cover in time of need but also a hassle-free and smooth experience during the processing of claims. Claim rejection is rare and medical bills of network hospitals are settled directly between the hospital and the insurance company. Only in cases of medical bills from non-network hospitals that customers have to claim reimbursement from the insurance company.

The process of making a claim is done completely online. Customers don’t need to send hard copies of medical bills to the Insurance Company. Sending soft copies through email is enough. Processing takes minimum time and clients are reimbursed within a few days.