Health insurance is intended to lessen the financial burden of medical care and to give you a financial safety net in the event that your health deteriorates. There are several various scenarios that might result in you having to file a claim against your insurance coverage. This might be the result of either a planned or unforeseen stay in the hospital. You can file a claim against your insurance in one of two ways: cashless or reimbursement. Both of these options are available to you. However, the processes for these two separate forms of health insurance claims are distinct from one another, and it is essential that you grasp the standards for each type in order to have an easy and stress-free experience.
Claims made without the use of cash
In the context of this form of claim for health insurance, the insurer (ACKO) compensates all of the medical expenditures (to the extent that they are covered by the policy) directly with the hospital. However, in order for the beneficiaries of the insurance to be eligible for the cashless method of claim payment, they must be hospitalised at a hospital that is part of the network.
Reimbursement claims
According to this form of claim for health insurance, you are required to pay the bill for the hospitalisation first before filing a claim for the reimbursement of the expenditures associated with the hospitalisation. You will receive the sum due to you from the insurer (ACKO), as stipulated in the terms and conditions of the insurance.
A procedure that does not need the use of cash for scheduled hospitalisation
In the event that you have a scheduled hospitalisation, the following phases make up the cashless claim process.
Make your selection from the hospitals that are part of the network according to the policy document.
Visit the information desk of the hospital’s insurance provider at least 72 to 48 hours before you are admitted and provide your policy card to begin the process of filing a claim.
Complete the pre-authorization form as well as any additional paperwork that may be necessary.
In the event that the claim is judged to be acceptable, ACKO will pay the hospital costs that are accrued up to the maximum amount that has been allowed in accordance with the terms and conditions of the policy.
You can pay the bills and then submit a claim to be reimbursed for the medical expenditures if your attempt to submit a cashless claim is denied.
The process that does not need the use of cash for hospitalisation during emergencies
In the event that you need to be admitted immediately, the method for filing a cashless claim is as follows.
Visit the hospital’s information desk for assistance with your insurance and bring your policy card with you.
To get started with your cashless claim, please fill out the pre-authorization form.
After taking into account any applicable deductibles, ACKO will immediately pay your claim with the hospital if it is determined that the case is admissible.
You have the option of submitting a reimbursement claim in the event that the cashless claim is not authorised.
The steps involved in submitting a claim for health insurance reimbursement
This is the procedure that has to be followed in order to get the money back for the hospital costs.
Notify your insurance company, which in this case is ACKO, about the medical care you will be receiving as well as the specifics of the hospital.
Make use of the medical services offered by the hospital of your choosing.
Pay down all of the outstanding medical costs.
Make sure that you get your hands on authentic hospitalisation records, such as the discharge summary, diagnostic and laboratory findings, medications, payment receipts, and so on.
You may get a copy of the health insurance claim form from our website, and then make sure you fill it out completely and accurately. Make sure that the hospital signs and seals all of the paperwork before sending them out. You can make a claim by submitting the common papers that are necessary, which are listed in the following section. You may submit your claim for compensation either online or by sending us a letter.
Along with the health insurance claim form, please include all of the documentation that pertains to the hospitalisation. In the event that your claim is validated, ACKO will handle the claim settlement in accordance with the provisions outlined in the policy. ACKO will let you know the reasoning behind the denial of your claim in the event that it is not accepted.