Aditya Birla Health Insurance Claim Settlement Process

What are Cashless Claims

Ever stuck in a medical emergency and were low on cash? Such an uncertain health emergency can drill a hole in your pocket, where you are required to spend your savings on hospital bills! Here's when a health insurance plan with cashless claim settlement acts as a saviour. Under a cashless facility, your insurer directly settles the medical bill with the hospital without you having to pay the bills first. Aditya Birla Health Insurance plans are no different. With a cashless treatment facility available at its wide network of 6500+ hospitals, you need not worry about those hefty hospital bills!

Aditya Birla Health Insurance has simple procedures that enable a hassle-free claim process. All you need to do is:

• Inform your insurer

In case of planned hospitalization, inform your insurer at least 1-2 days in advance and in case of an emergency, notify within 24 hours

• Submit documents

Submit the required documents like health card, identity card and medical report

• Insurer’s assessment

Your insurance company verifies the details against your health insurance policy coverage and terms

• Claim decision

If your claim request is within the coverage, approval is sent to the hospital for the specified amount.

Documents Required for Filing Cashless Claim

Take care of the following documents when filing a cashless claim with Aditya Birla Health Insurance:

• Duly filled Claim Form
• Photo ID & Age Proof
• Original Discharge Card of the Hospital / Day Care Summary / Transfer Summary
• Previous consultation papers mentioning history & treatment details for current ailment
• All the original final Hospital Bill with all original Deposit & Final Payment Receipt
• All original diagnostic reports, Medical Practitioner’s prescription & invoice / bill with receipt from diagnostic centre
• If claims are above Rs. 1 Lakh, CKYC form duly filled and signed by proposer with residential proof copy & photo ID
• All Original Pharmacy and medicine bills along with doctor’s prescription

What are Reimbursement Claims

A medical uncertainty could strike anytime, anywhere. But if you are covered under a health insurance plan offering reimbursement claim settlement, all you have to do is get your treatment done, pay the complete hospital bill, retain all the original bills and receipts and request a reimbursement! Once approved, your insurer reimburses the claim amount by transferring it directly to your bank account. This is why, reimbursement claims may be comparatively more time-consuming. Having said that, unlike cashless claims, reimbursement claims can be filed for treatments done in non-network hospitals too. 

When making a reimbursement claim, follow the steps below –

• Intimate the insurer

Informing your insurance provider even during the reimbursement claim process

• Submit documents

After the necessary medical treatment, submit the documents like claim form, discharge summary, medical bills, and OPD expense bills with your insurance company.

• Claim verification

After verification documents against the claim, your insurance provider will either accept or deny your claim request

• Claim decision

If the claim is approved, the said amount is disbursed

Document Required for Filing Reimbursement Claim

Take care of the following documents when filing a cashless claim with Aditya Birla Health Insurance:

• Duly completed Claim Form
• Photo ID & Age Proof
• Original Discharge Card / Day Care Summary / Transfer Summary
• Original final Hospital Bill with all original Deposit & Final Payment Receipt
• All previous consultation papers indicating history & treatment details for current ailment
• All original diagnostic reports along with doctor’s prescription & invoice / bill with receipt from diagnostic centre
• All Original Medicine / Pharmacy Bills along with doctor’s prescription
• Cancelled cheque copy for proposer with pre-printed name. In case name is not pre-printed, please provide copy of bank passbook/bank statement
• If claims are above Rs. 1 Lakh, CKYC form duly filled and signed by proposer with photo ID and residential proof copy 

Why Your Aditya Birla Health Insurance Claims May Get Rejected

Here are some reasons why your claims on your health insurance policy may get rejected:

• Misinterpreted details

In case any incorrect details and information are provided during the claim, the claim stands rejected as the insurer assesses the claim as per the details provided

• Excluded incident

In case you file a claim for an incident that is excluded from your health insurance policy, your claim may get rejected

• In-active policy

In case you file a claim after your policy is lapsed, your claim would be denied

• Delay in intimation

In case you fail to inform the insurer regarding the incident, your insurer may not be able to fully assess the scenario, resulting in claim denial

• Waiting period

In case you file a claim for the expenses of the treatment of a disease having a certain waiting period which is still not completed, your claim could be denied.

Note: Kindly refer policy wordings to check complete list of policy exclusions.

We are Here to Help You

Best Health Insurance Plans Available at Finserv MARKETS