How to reduce the chances of delay in your medical insurance claim

Date : 01/09/2022
Read: 3 mins

Reduce the chance of delay of your medical insurance claim!

How to reduce the chances of delay in your medical insurance claim

You have bought the health insurance and paid your premiums on time. You went to the hospital and checked in with the cashless treatment option. Still, your medical insurance might be delayed. There are several reasons for the delay in your medical insurance. The Byzantine process of claim processing is used to intimidate even the sincerest policyholders.

The hospitals have a claim settlement department which coordinates with the Third Party Administrators (TPAs) to settle the claims. TPAs are third-party outsourced agencies which have been given the power to settle the claims on behalf of the insurance company. But still, your claim might be delayed. Here are the reasons why!

Reasons for delay in medical insurance claim

There are several reasons for the delay:-

Pre-admission formalities- Insurance companies want you to report the claim 48 hours before admission to a hospital. You need to provide all the details like the hospital name, date of surgery, medical tests and diagnostic reports and the doctor’s recommendations. The TPA checks the claim documents and issues a pre-authorization along with an initial amount. This process is necessary to ensure that there are no delays in claim processing.
Discharge process- before you are discharged from a hospital, there are several formalities that need to be completed. When the discharge summary is released, only then will the claim be processed. The formalities required for discharge summary require the doctor’s signature. The doctor reviews the documents, and there is back and forth. Finally, after the discharge summary, the hospital prepares the final bill. A delay in discharge summary might cause the bill to take more time.
Hospital and TPA coordination- The TPA and the hospital need to be in sync about the procedure. The TPA raises the query, and the hospital needs to reply to the queries. If the coordination is poor, there might be a delay in the discharge process.
Costs associated with the delay- A delay might cause you to occupy the bed for longer and will be a cost for the hospital. Also, in a country with shortages of beds, this is not ideal. Therefore, minimizing the delay is necessary. Also, your food and other costs might need to be directly borne by you.

How to get your medical insurance claims processed faster?

As a policyholder, you should ensure that you check in to an empanelled hospital only. Also, you are expected to understand the policy intricacies to make sure your claim is not delayed or rejected. You should also keep all your documents in order to ensure fast processing of the claim. Also, you should stay in touch with the TPA to make sure that no documents are pending on your side. If you ensure all this, the chances of delay are less. But the delay on the hospital side can still be there.

On the hospital side, there is a need to increase the use of AI to prepare the discharge summary. AI can help in preparing the discharge summaries simultaneously. In the UK, the NHS is using AI to prepare discharge summaries. Their electronic discharge summaries complete the details automatically, and it is submitted to the doctor for approval. Here's what you need to know about Group health insurance Vs Individual health insurance

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Reasons for delay in medical insurance claim

There are several reasons for the delay:-

Pre-admission formalities- Insurance companies want you to report the claim 48 hours before admission to a hospital. You need to provide all the details like the hospital name, date of surgery, medical tests and diagnostic reports and the doctor’s recommendations. The TPA checks the claim documents and issues a pre-authorization along with an initial amount. This process is necessary to ensure that there are no delays in claim processing.
Discharge process- before you are discharged from a hospital, there are several formalities that need to be completed. When the discharge summary is released, only then will the claim be processed. The formalities required for discharge summary require the doctor’s signature. The doctor reviews the documents, and there is back and forth. Finally, after the discharge summary, the hospital prepares the final bill. A delay in discharge summary might cause the bill to take more time.
Hospital and TPA coordination- The TPA and the hospital need to be in sync about the procedure. The TPA raises the query, and the hospital needs to reply to the queries. If the coordination is poor, there might be a delay in the discharge process.
Costs associated with the delay- A delay might cause you to occupy the bed for longer and will be a cost for the hospital. Also, in a country with shortages of beds, this is not ideal. Therefore, minimizing the delay is necessary. Also, your food and other costs might need to be directly borne by you.