Time Limit for Filing a Health Insurance Claim

Posted on: Aug 17, 2022 | | Written by:

Time Limit for Filing a Health Insurance Claim

Health insurance has always been important, and in the wake of the pandemic, it has gained the attention it deserves. And rightly so. Health insurance makes it possible for more and more people to avail quality healthcare, which is otherwise too expensive. Depending on the type of policy you buy, you can expect good coverage as well, even for critical illnesses. And in lieu, you need to pay a monthly or yearly premium. This way, in case you get hospitalised for some treatment, you can ask your insurer for financial coverage. However, just like everything else in life, claim filing for medical insurance comes with a set of rules. This helps insurance companies to protect themselves against spurious claims. Read on to know all about it.

Concept of Time Limit in Health Insurance Claims

Time limit is a concept that has always been present in different types of medical insurance policies. It lays down the need to present the claim within a specific period from the time the event takes place. Insurance companies need to process the claim after analysing certain documentary and non-documentary evidences, which in many cases may only remain available for a very limited period. By ensuring that claims are filed in a timebound manner, companies can process claims faster and examine the evidence while it remains available.

Need of Time Limit in Health Insurance

• Providing money when it is needed the most:

This is perhaps the most important reason why time limits are introduced. By ensuring that claims are filed in a timely manner, insurance companies can provide the money when you need it the most.

• Spreading out the claim load:

By imposing time limits, insurance companies can prevent extra workload on human and financial resources. This is because claim requests will flow in on time and it will be possible to deal with them.

• Reducing the risk of spurious claims:

Fraudulent and spurious claims have always been the bane of insurance companies, and by imposing time limits, they can reduce the risk of such claims.

Time Limits in Cashless Mediclaim

Almost all insurance companies today provide the option of cashless insurance. This way, if you need treatment of any kind, you simply need to inform the insurance company and fill the form and get it protected by the healthcare professional or hospital. Here, the time limit is generally front working, meaning that you need to send the forms for pre-approval at least a minimum number of days before the procedure or hospitalisation begins. Hence, insurance companies will get enough time to conduct due diligence before giving any approvals.

Also Read: How Does Cashless Claims Work?

Time Limits in Emergency Cashless Mediclaim

As is obvious from the name, emergency cashless Mediclaim needs to be filed in case of any medical emergency. It can be because of accidental injuries, unexpected medical problems or complications etc. There is generally no forward time limit on making insurance claims in case of emergency claims, because it won’t be much of an emergency if you can plan for it or predict it. On the other hand, insurance companies may respond to emergency cashless claims within certain timelines to ensure that they can stand with policyholders when they need the insurance cover the most.

Time limits in reimbursement claims

Often, you may not be able to go to a cashless network hospital, may be because it is not near you or maybe it does not have the staff or resources to cater to specific problems. In such cases, the insurance company allows you to choose a non-network medical institution for treatment, clear the bills on your own and file reimbursement claims. After this, you are given a maximum of 90 days, though this may differ from policy to policy, to file the claim and get reimbursement.

Time Limits in Post Hospitalization Claims

Even after your discharge from a hospital, there may be a lot of medical and other expenses which are covered by the medical insurance policy. These can be claimed by submitting claim forms, bills as well as other identity and medical documentation. Generally, this needs to be done within 90 days, as counted from the date of discharge from the hospital. However, in some cases, some claims can be counted from the date mentioned on the bill. These bill-based claims may get shorter than the usual 90-day window.

Documentation Needed for Claim

Different kinds of paperwork may be needed for filing the claim, though some specific documents remain the same. Some common documentation needed include a copy of the insurance policy, identity proof of the policyholder, bill from the hospital, medical summary from the hospital, and financial documents where money needs to be sent.

Conclusion

All in all, you need to be careful about the time limit of filing a medical insurance claim. Otherwise, you might end up with too many complications or you might not get any money at all.

Disclaimer: The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales.

How To Check Claim Settlement Ratio?

Can we claim 80d and 80ddb together?

What are the New IRDAI Rules for Health Insurance Claim Settlement?

How to File a Health Insurance Reimbursement Claim?

Health Insurance –How to Make Claims from Two Insurance Companies