First things first
Filing a health insurance claim shouldn't feel like solving a puzzle. But let's be honest.it often does.
Here's everything you need to know, in plain language.
Two ways to claim
Cashless: Insurance company pays the hospital directly. You pay nothing upfront (except for things not covered).
Reimbursement: You pay the hospital first, then claim the money back from insurance.
Cashless is obviously easier. Let's start there.
How cashless claims work
Step 1: Go to a network hospital
Your insurer has a list of hospitals they've tied up with. These are "network hospitals." Check the list before you go.
In an emergency? Any hospital is fine. But for planned surgeries, stick to the network.
Step 2: Inform your insurer
Call the toll-free number on your insurance card. Or submit a request online. Do this within 24 hours of admission.
Most insurers have a TPA (Third Party Administrator) that handles claims. Your hospital's insurance desk can help with this.
Step 3: Submit pre-authorization
The hospital will fill out a form with details of your treatment. This goes to the insurer for approval.
This usually takes 2-4 hours. Sometimes longer for complicated cases.
Step 4: Get treated
Once approved, proceed with treatment. The insurance covers the approved amount. You pay only for things not covered (like personal items).
Step 5: Settle the final bill
At discharge, you'll only pay the difference between total bill and what insurance approved.
How reimbursement claims work
Sometimes cashless isn't possible. Maybe the hospital isn't in the network, or the pre-authorization got delayed.
Here's how to get your money back.
Step 1: Pay the bill and collect everything
You'll need:
- Original hospital bills (itemized)
- Discharge summary
- Doctor's prescriptions
- Lab and test reports
- Pharmacy bills
Keep originals of everything. Photocopies won't work.
Step 2: Fill the claim form
Download from your insurer's website or get it from their office. Fill it carefully.wrong information means delays.
Step 3: Submit within 30 days
Most insurers need documents within 30 days of discharge. Don't wait till the last minute.
Step 4: Track and follow up
Once submitted, get a claim number. Check status regularly. If there's no update in 15 days, call them.
Step 5: Get your money
If everything is in order, you'll receive the amount in 15-30 days.
Pro tips from our experience
- Save your insurer's helpline in your phone now (not during an emergency)
- Take photos of all documents before submitting
- Keep your policy number and card accessible
- For planned procedures, get pre-authorization 2-3 days in advance
Why most people mess this up
They don't know the process. They panic. They miss deadlines. They submit incomplete documents.
This is exactly why we exist.
At YASHURE, we handle claims for our clients. We collect documents, file the claim, follow up with the insurer, and fight for you if something goes wrong.
That's what proper insurance advice looks like.