What is the time limit for filing a health insurance claim?

Buying a health insurance policy is a huge decision. You look into the coverage, premium, and other information to get the best cover and services for your medical needs. After spending days researching for the best offers, you decide to buy a health plan that suits your interests. Imagine all of this going in vain during the claim settlement process. You want to ensure you can put your insurance policy to use by raising the claim on time to avoid this. Hence, knowing the time limit to do so is essential. 

The health insurance claim time limit varies based on your insurer. It also depends on the type of claim. Understanding these factors lets you make a wise decision and avoid the whole process of buying health insurance from getting wasted. It is also a proactive measure to reduce the hassle when you seek immediate medical assistance. Read on to learn the what, why, and how of filing an insurance claim within the time limit. 

What is the mediclaim reimbursement time limit?

The time limit for different types of claim settlement procedures works in the following ways:

Cashless claim settlement

Insurers provide a beneficial feature known as cashless claim settlement to facilitate the claim process. Under this facility, you need not run around paying the bills during a medical emergency. The insurance company takes care of this on your behalf. 

Your job is to inform the insurance company two to four days before getting hospitalised for a planned hospitalisation. With this, you must also submit a cashless claim form stating the details of the medical treatment. After verifying the information, insurers provide a confirmation letter/reference number. Submit this along with your hospital card while getting hospitalised. The rest gets settled as insurers and the network hospital co-ordinate. 

Emergency hospitalisation

Unlike planned hospitalisation, not all medical treatments are predictable. In fact, most of them are a result of unexpected medical mishaps. In such cases, there is no time to waste. Therefore, the time limit for submission of a medical claim is 24 hours after getting hospitalised. Ensure you find a network hospital to speed up the claim settlement process. 

Reimbursement claims

You can raise a claim under this method if you get admitted in a non-network hospital. With reimbursement, insurers compensate your medical expenses after you settle the bills yourself. The claim amount depends on the health insurance terms and your coverage. As no prior intimation is required, the health insurance time limit for reimbursement starts after hospitalisation. The exact duration for reimbursement claim differs from insurer to insurer. However, the typical timeline is between 7 and 15 days after the date of discharge from the hospital. 

Post-hospitalisation claim

If you remain hospitalised for an extended period and want to claim reimbursement of medical expenses after getting discharged, there is a separate time limit. It is generally 2 weeks or 15 days after 60 to 90 days of hospitalisation. Consult your insurer or study the terms related to the policy document. These details get mentioned in your health insurance policy for an accurate understanding. 

Why do insurers set a time limit for the submission of medical claims?

Health insurance policies are meant for your medical protection. They come in handy to rescue you from inflating healthcare costs. But some policyholders try to misuse the benefit to make false claims. Hence, setting a mediclaim reimbursement time limit is an effort by insurance companies to prevent fraudulent claim requests. 

By setting a time limit, they avoid the possibility of falsifying the claim-related details. Another purpose is to ensure that claim settlement is processed as soon as possible. This is because insurance companies may have traffic of multiple claims, which make settling last-minute claim requests difficult.  

How to file health insurance claim within the time limit?

Keeping track of the health insurance claim time limit is one way of ensuring timely claim settlement. Another important step is getting all the required details and documents ready beforehand to avoid the last-minute hassle. This involves the following proactive measures:

• Verify the bill details. Cross-check the listed expenses against the incurred costs to ensure there are no errors. 
• Gather the required documents to attach to your claim form. Some of them include hospital receipts, diagnostic reports, medical prescriptions, discharge cards, indoor case papers, etc. 
• Do regular follow-ups with the hospitals to acquire treatment-related documents, as you may have to wait to receive them. 
• Check the notification for the claim/approval or rejection. You should receive it within the specified timeline in your email inbox. 
• If your first claim gets rejected, take the necessary action to raise an alternate claim immediately. Also, fix the errors that led to the rejection of your first claim. 
• Locate the cashless hospital under the insurers’ network to smoothly get through the claim process. 
• Ensure your insurance is valid, make claims under the coverage, and pay special attention to exclusions. 

Final Note

Now that you know how the mediclaim reimbursement time limit works, ensure that you note the limits on different types of claims. Also, use the tips mentioned above for a smooth claim settlement and to avoid rejections. Getting reimbursed or settling medical bills should form a top priority for you after getting hospitalised. 

Understandably, a medical emergency can lead to emotional distress, which may make it difficult to go through the claim procedure. But insurers have made it easy to file a claim online through their website or apps. It takes a few minutes if you have all the documents handy. Use this convenience to your advantage and avoid waiting too long to initiate the claim process. Start making arrangements as soon as you detect the need to get medically treated.