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A complete guide for health insurance claims: Handling multiple claims

There might be instances when you incur multiple claims. Multiple claims mean claiming from more than one insurance company which could occur if your hospitalization bill exceeds the total coverage of a single health insurance plan.

Handling multiple claims

  1. Cashless + cashless:
  • Apply for 2 simultaneous cashless claims in the same hospitalization
  • Inform both the insurance companies independently of the claim. Also mention the fact that you are making more than one claim for the same hospitalization.
  • Register your claim separately with each insurance company/TPA by filling up the pre-authorization forms and other documents
  • Once approved, the hospital would send the medical reports and other documents to both the insurers. You can get cashless treatments and the insurance companies would handle the claim.
  • The pre and post-hospitalization expenses would have to be settled on a reimbursement basis. So, after you have recovered, you can fill up the Claim Form and submit all the documents to the insurance company from where you want to get the reimbursement for the pre and post-hospitalization expenses.
  1. Cashless + reimbursement:
  • Apply for one cashless claim and then file for reimbursement of the rest of the amount.
  • Inform both the insurance companies of the claim and register your claim with them.
  • Choose an insurer for the cashless claim process and fill up and submit the pre-authorization form for approval. Follow the cashless claim process and get your claims settled on a cashless basis from one insurance company.
  • For the rest of the claim which is to be made on a reimbursement basis, pay the remaining amount at the time of discharge.
  • After discharge, fill up the Claim Form and attach all the relevant documents needed to make a reimbursement claim. You would also have to submit the Claim Settlement Letter issued by the first insurance company which states the claim amount already settled.
  • Also, the certified true copies of the medical bills and hospital reports need to be availed from the first insurance company so that you can submit them to the next company for reimbursement of the claim
  • After the reimbursement claim is filed, the insurance company would pay for the remaining amount.
  1. Reimbursement + reimbursement
  • Opt for one reimbursement claim and then proceed to the next reimbursement claim after one is settled.
  • Again, inform both the insurance companies of the claim and get the claims registered
  • You would have to follow the reimbursement claim process for one insurer first.
  • Once a part of the claim is settled, you would also get a Claim Settlement Letter. Also, avail of the certified true copies of all original medical and hospital bills from the insurance company to file the second claim.
  • Again follow the same process to file another claim with the subsequent insurer with the certified true copies of the treatments, medicines, and bills issued by the first insurer and also the Claim Settlement Letter.
  • The remaining amount would then be settled by the second insurer. 

Are COVID claims different from regular ones?

COVID claims are also settled on a cashless or on a reimbursement basis. So, you would have to follow the cashless or reimbursement claim process for getting the claim settled for your regular individual or group health plans.

However, for the Corona Rakshak plan, which is a fixed benefit policy, you would have to submit a prescription recommending hospitalization and proof of hospitalization for at least 3 continuous days.

Moreover, for Corona Kavach and Corona Rakshak plans, a copy of your passport and its pages would also be required to rule out international travel. 

Things to know when making a health insurance claim

Here are a few things that you should remember when you claim under your health insurance policy to minimize delays and rejections:

  1. Find out the room rent from the hospital before admission. Check if your health plan has any room rent limit. If there is a limit, try and choose a hospital whose room rent is within the limit. If you exceed the limit, your inpatient hospitalization claim would be proportionately reduced.

    Here’s an example. 
    1. Say your health plan allows a room rent of Rs.10,000 and you get hospitalized in a hospital where the room rent is Rs.12,000. Now, if your total inpatient claim amounts to Rs.1.2 lakhs, the insurance company would pay only Rs.1 lakh in claims. The rest would be borne by you.
    2. So, if you want to reduce your out-of-pocket expenses, ensure your room rent is within the approved limit.
  2. Check the policy exclusions to know what is covered and what is not covered.
  3. For planned hospitalisation, it is always a good idea to get a pre-authorization approval of the claim so that there is no confusion or delay at the time of claim disbursal.
  4. The initial approval might get delayed. In such cases, the hospital might ask you for a deposit so that treatments can begin. Make the deposit. It would not affect your claim. Once the deposit is approved, the hospital would refund the deposit or adjust it against your out-of-pocket expenses.

Remember to keep a copy of all the bills and originals submitted, especially for a reimbursement claim so that in case of a dispute, you have documentation to fall back on!

So, know the health insurance claim process and educate your family members about the same so that the next time any medical emergency strikes, you and/or your family members know how to claim the health insurance policy.

Want to read more about cashless & reimbursement claims? Click here.


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