8 Questions on Health Insurance Claim and Their Answers

health insurance claim

We came across a few queries on  MediBuddy’s insurance claims portal that troubled users. Well, insurance and claims can be tricky…there can be a million problems — well, maybe even more. But in this post, we’ve identified 8 queries — and their answers — which can help make your journey easy-breezy on MediBuddy.

Query #1: Why is it important to submit a cheque leaf?

You will be required to submit a cancelled cheque leaf during a health insurance claim process as it acts as a proof of the individual holding the account. Moreover, it aids in the electronic transfer of funds by eliminating any typographical errors and/or false information about your bank details.

Query #2: Where do I see the policyholder and dependant(s) details in the portal?

You can view your insurance policy details, coverage, terms and conditions, and dependant information by clicking on ‘Policy Detail’ after signing into MediBuddy.  It’s important to note that dependants can be only be removed/added while your policy’s enrolment window is open.

Query #3: Where do I find policy terms and coverage details on MediBuddy portal?

Log into MediBuddy and navigate to ‘Policy Detail  where you’ll be able to see:

  • Policy Terms and Conditions
  • Policy Coverage
  • Dependant(s) information
  • Family Sum Insured
  • Balance Sum Insured
  • Insurer Name
  • Policy Name

 

Query #4: Why is it necessary to send the physical copies during insurance claim submission despite uploading the soft copies?

Physical copies are required during an insurance claim submission for the following reasons:

  • A direct mandate from insurers (not all) demanding all original medical records. Please check your policy terms and conditions to know more.
  • To prevent any discrepancies, fraudulent activity, and overinflation of claim amount. Moreover, these documents help in the auditing of the TPAs and the Insurers.

Providing up-to-date information and the originals is one way to ensure that your claim isn’t rejected or denied. Complete disclosure and submission of original documents add authenticity to your claim. Here are the documents you’ll have to submit while submitting a cashless or a reimbursement claim.

Query #5: Why is there a delay in approval of claims?

There can be a variety of reasons why your claim might be delayed: treatment/ailment not covered under your policy, invalid/expired policy, inaccurate information, and more. Here’s a post that talks more about the delay in claims in detail.   

Query #6: Who do I contact if I have a problem in uploading the documents/govt id proof?

Uploading documents on MediBuddy shouldn’t be a hiccup. However, in the unfortunate event of a failed document upload/submission, you can:

  • Call the Claims Helpline on the Contact Page or drop a query under ‘Your Queries’ on the after logging into MediBuddy

 

Query #7: Why is it required to fill in Date of Admission and Date of Discharge for domiciliary claims?

You won’t have to fill in the date of admission and discharge to raise a domiciliary claim but have to mention the duration of treatment,  including the documents listed below.

  • Claim form
  • Doctor’s prescription which must contain the line of treatment, nature of the ailment, medicines dispensed or prescribed for treatment, and the duration of treatment. The prescription must not contain payment details.
  • Pre-numbered doctor’s original bill from doctor’s official bill book
  • Original cash memos/chemist bills for medicines purchased
  • Copies of all lab test reports and other test reports ( if applicable )

Domiciliary treatment covers all ailments (subject to policy terms and conditions) that do not require hospitalization which also includes treatment taken at the OPD in a hospital or a physician.

Query #8: Which types of claims are usually denied/rejected?

The waiting period and the terms and conditions of your insurance policy are a couple of reasons behind a claim rejection. Here’s an article that lists all the reasons that open the door for claim rejections, cashless or reimbursement.

Help is at hand, with MediBuddy!
Let MediBuddy help you plan better. View the details of your policy, including exclusions and other conditions, online; use the Network Hospital search feature to locate, compare and choose an ideal hospital for cashless treatment; and use the Online Claim Submission feature to not only enjoy hassle-free claim submission but also reduce instances of deficient documentation.

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