By Pankaj Nawani


Best health insurance claims experience is the one where you don’t have to make any payment i.e. cashless. While cashless transactions generally provide a seamless claims experience, there are instances where cashless processing may not be feasible. The hospital where the patient is admitted might not be in the cashless network, the claim processing might take longer than anticipated or the sheer emergency of the situation might dictate immediate payment. Therefore, it’s very important that the health insurance customer should know what to do in a reimbursement claim situation.


First step towards a smooth and fast reimbursement claim is to keep handy all the details like the email id and phone numbers that your insurance company has shared with you for getting in touch with them. This should be done the moment you purchase the policy and this information should be shared with your family. It should not only be kept in your own diary or google drive.


It is also advisable to go to your health insurance company’s website and take prints of their claim’s forms. This will not only make sure that you have a head start on documentation, paying attention to the claims form will also help you understand your health insurance policy better. As we often tell our customers, the best health insurance policy is the one that you understand clearly. Also keep handy printouts and softcopies of all ID proofs like Aadhar, PAN, Birth certificate etc.  It is not uncommon to find the patient’s family struggling to locate the right document in their home or digital devices at the time of claims.


Also, we advise our customers to please make sure that you update this information at the time of policy renewal. The contact email id and mobile number that you filled in your initial form might not be operational today. Also, as technology progresses there are always new ways of getting in touch like AI chatbots and WhatsApp communication which are being introduced by the best health insurance companies in India. You should keep yourself updated.


Second, in case your surgery is planned, and as per expert estimates 80 per cent of surgeries are planned, please make sure that you get in touch with your insurers and keep them updated. This will help the insurance customer service staff to guide you on the process to be followed. While this might seem like a tedious task, fact is that insurance companies are giant corporations with specifically laid down processes, deviations from which while possible are infrequent, painful and time consuming.


You might think you have the best health insurance policy purchased from the country’s best health insurance company and through an agent you trust but it is advisable to be pragmatic and get to know the process beforehand. This step will also increase the odds of your claims being processed in a cashless manner and avoid the pain of having to file a reimbursement later.


In case there is an emergency or the cashless facility is denied, know your claims and stay calm. If you have done the pre work as we have suggested earlier in this blog, you are already ahead of the game. Now there are four things that every reimbursement claim requires:



  1. Medical certificate issued by the treating physician which describes your health issue in detail for your insurance company.

  2. Diagnosis Report of all the tests conducted pre and post operation like x-ray, blood tests, MRI etc. This is needed by your insurer to corroborate the medical certificate.

  3. Discharge Summary from the hospital which gives the full account of hospitalisation.

  4. Original Bills for medicine, consumables, diagnostics etc.

  5. FIR in case of an accident or foul play.


We strongly advise you to arrange these neatly in order of date and also make a high-resolution soft copy of all of the above. You will need to utilise the online claim settlement option of your health insurance company. In case your health insurance company requires you to send the physical document you will have all of the above ready and your claim will be processed easily.


Last Pro tip for our customers is that the original documents that you sent to the insurer, you can and should ask to get them back. These documents are part of your medical record history and therefore very important. Please make sure that you get these documents back from your insurer.


The author is the CEO of CarePal Secure.


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