Facts you must know before making insurance claim for Covid-19 treatment expenses

In the second wave of Covid pandemic, the infection rate is much higher than the first wave are many people are getting treated for the disease either at home or in a hospital. But it is important to know certain facts and rules in order to be able to claim the treatment related expenses from your health insurance company. Worth mentioning here is that home Covid care is also covered by many heal plans. Here are the facts that you must know to ensure a hassle-free claim settlement.

1) Following the regulator's guidelines around Covid claims, most of the insurers have reduced the claim settlement turnaround time.

2) If you notice any symptom related to covid-19, you first need to get yourself tested from only a government authorized lab.

3) Once you are detected positive for the virus, inform your insurer about the nature of treatment you are undertaking—whether it is under home care, quarantine, or treatment in a hospital—to avoid any confusion during claim settlement. This information will help your insurer in assessing your claim as per the terms and conditions of the policy and will reimburse accordingly.

4) Most of the comprehensive and standalone Covid health policies cover pre- and post-hospitalization expenses, ambulance charges, and treatment costs related to covid-19.

5) In case of hospitalisation, you need to undergo pre-authorization approval by the insurer or by the third-party administrator (TPA) desk in the hospital. So you need to have doctor's recommendation for hospitalisation. Also, you need to ensure that you have submitted all documents before hospitalization and follow up treatment after discharge along with bills.

6) For getting your claim settled, you need to have discharge summary from the hospital. It helps the insurer know the condition of the patient pre-and post hospitalisaion and the number of days he stayed in hospital for treatment.

7) In case you are getting treated at a network hospital you can get cashless facility. But in case of treatment at a non-network hospital, you will receive your treatment expenses as reimbursement.

8) The documents that are required at the time of claim settlement are RT-PCR report, PAN card, Aadhaar Card and medical health card, hospital discharge summary and the advice from a doctor for hospitalisation.

9) Worth mentioning here is that your hospital, in spite of being a network hospital may deny cash-less claim. in such a case you need to raise a complaint with your insurer and raise it with insurance ombudsman and even send the grievance to IRDA.