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Claim Process for Health Insurance in UAE

A health insurance claim is a request that a health insurance policyholder makes to the Insurance Company in order to access the treatments that their policy covers. For the medical services received, a health insurance policyholder can either be reimbursed or choose the direct claim settlement option (also known as cashless treatment). This allows you to either file a claim form or seek cashless services from your health insurance provider.

Health Insurance Claim Types

The ultimate utility of a health insurance plan is to provide healthcare services when they are required. The health insurance claim process must be started in order to ensure prompt and easy payment of all medical bills. A health insurance coverage can be claimed in one of two ways:

Cashless Claims

This sort of health insurance claim involves the insurer directly settling all medical bills with the hospital. To receive the benefit of cashless hospitalization, an insured must be admitted exclusively to a network hospital.

Reimbursement Claims

In this form of claim, the policyholder pays for the hospitalization costs up front and then asks the insurance company for reimbursement later. In the United States, reimbursement is available at both network and non-network hospitals.

Health Insurance Authorization Process

When an insurer receives notification from the policyholder's attendant and is contacted by the hospital (network) about it, the insurer confirms the validity of the policy and the policyholder's coverage. Then a field doctor is assigned to help with the pre-authorization document request and to double-check the treatment claims. After verification, the insurance company's medical team accepts the cashless claim for the policyholder based on the policy's terms and conditions.

Important Requirements for Filing a Health Insurance Claim

  • If the details are not completely filled out, the authorization process may be canceled.
  • Within 30 days of the discharge date, all claims must be filed.
  • All non-payable things must be paid by the insured on their own.
  • To collect the total post-hospitalization expense, all required paperwork must be submitted within 30 days of discharge.

Procedure for Filing a Health Insurance Claim

For Cashless Claims, the Claim Settlement Process is as follows:

The following is the usual method for submitting a cashless claim for a health insurance policy:

  • Contact the hospital's insurance help desk.
  • For identification purposes, show the insured's ID card, which was issued by the health insurance provider.
  • The hospital will verify the insured's identity and submit the pre-authorization paperwork to the insured's health insurance provider.
  • All of the provided documentation will be reviewed by the insurance provider, who will then process the claim in accordance with the terms and conditions of the health insurance policy.
  • Some health insurance companies additionally provide a field doctor to help the insured navigate the hospitalization procedure.
  • The claim is settled according to the policy's terms and conditions after all requirements have been completed.

Two Forms of Cashless Health Insurance Claims

Two forms of cashless health Insurance claims: -

Planned Hospitalization

When the policyholder is aware of the hospitalization ahead of time, it is referred to as planned hospitalization. In this scenario, the steps to seek cashless treatment are as follows:

  • Before you go, call the health insurance policy provider's toll-free helpline.
  • Fax the pre-authorization form to the health insurance provider's fax number, which must be filled out completely by the hospital.

Emergency Hospitalization

In most cases, an emergency hospitalization is required when the insured is involved in an accident or suffers from an ailment that necessitates rapid medical attention.

After admitting the patient to the hospital, the family of the insured is advised to contact the health insurance provider on their toll-free number.

Within 24 hours after hospitalization, the pre-authorized form (completed) must be faxed to the health insurance provider's numbers

Health Insurance Reimbursement Claims Settlement Process

The following is the usual method for submitting a reimbursement claim for a health insurance policy:

  • Contact the hospital's insurance help desk.
  • For identification purposes, show the insured's ID card, which was issued by the health insurance provider.
  • The hospital will verify the insured's identity and submit the pre-authorization paperwork to the insured's health insurance provider.
  • All of the provided documentation will be reviewed by the insurance provider, who will then process the claim in accordance with the terms and conditions of the health insurance policy.
  • Some health insurance companies additionally provide a field doctor to help the insured navigate the hospitalization procedure.
  • The claim is resolved after all requirements have been completed.
  • The claim is settled according to the policy's terms and conditions after all requirements have been completed.

Documents Required for Filing a Health Insurance Claim

  • Health Card (Health Insurance ID Card)
  • All the consultation papers provided by the doctor
  • Completely filled claim for
  • All the investigation and diagnosis reports, such as CT scan, X-ray, blood reports, etc.
  • In the case of an accident, provide the Medico Legal Certificate (MLC)
  • Invoices of the pharmacy with respective prescriptions.
  • Discharge summary
  • All other relevant documents

Conclusion

As we can see getting a Health Insurance Claim is not a big task you just need to be aware of the of the type of insurance. Many companies at UAE are providing great insurance covers. We hope this article gave you a good insight of how to claim an insurance, its benefits and documents needed, to know more about the topic you can connect to our experts at Dhanguard we would have great delight to assist you. You can also visit our website to learn more.

Frequently Asked Questions

Patients are communicated to tell their physicians all about their medical history in order to get the best care, and health insurance policyholders are asked to tell their provider all about their pre-existing conditions in order to get the best coverage. Furthermore, if there are any inconsistencies in the medical insurance policy, the insurance company can cancel the policy.

The regional limit to which a health insurance policy's benefits are available is referred to as the scope of coverage. For example, in the UAE, health insurance with a definition of ‘Within the UAE' would only compensate policyholders for medical services received in the UAE.

Family policies undeniably deliver some of the best coverage at the most affordable prices, making them one of the most cost-effective health insurance choices in the UAE. Even family health insurance policies, however, have their own limitations, such as a limited number of dependents and other constraints. When applying for a job, it is suggested that applicants spend some time reviewing the different inclusions and exclusions.

Medical insurance Policy for females are expensive because of the pregnancy related costs that occurs to the insurance companies. Whereas policy for female aged below 40 is too expensive compared to female aged above 40.

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