What is Reimbursement? Steps to avoid claim rejections:-
Health claim reimbursement is a process in which an insured person pays for medical expenses out of pocket and later claims the amount from their health insurance company. It is one of the two common ways to settle a health insurance claim — the other being cashless claim.
How Health Claim Reimbursement Works:
Hospitalization & Payment:
You get treated at any hospital (network or non-network) and pay all medical expenses upfront.Collect Documents:
Gather all original bills, discharge summary, prescriptions, reports, etc.Submit Claim to Insurer:
Fill out the claim form and submit it along with all documents to your insurance company (usually within 15–30 days after discharge).Claim Review:
The insurance company reviews your claim to ensure it is valid and covered under your policy.Approval & Reimbursement:
If approved, the insurer transfers the approved amount to your bank account.
Documents Generally Required:
Duly filled claim form
Original hospital bills and receipts
Discharge summary
Doctor’s prescription and consultation papers
Investigation reports (X-ray, MRI, blood tests, etc.)
Copy of health insurance card or policy
Cancelled cheque or bank account details
When is Reimbursement Needed?
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Treatment taken in a non-network hospital
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In emergency where cashless not possible.
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Cashless request denied or delayed.
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OPD, home care, or pre/post-hospitalization where you paid first.
Key Tips:
Always inform the insurer within 24–48 hours of hospitalization.
Keep original documents safe and organized.
Check your policy for claim submission deadlines and exclusions.
