Direct settlement is when the bills are paid directly to the provider.Usually happens when the insurance company has its own network of hospitals
and clinics. There is no hassle of paying bills, filling up claim form,fowarding it and then waiting for the payment to come through. The insured, however, is
required to pay deductible at the hospital desk.
Reimbursement is when the insured settles all the expenses incurred and
later claims it from the insurance company usually by filling up a claim
form and submitting all the original bills along with supporting
documents.The deductible and co-insurance, if any, would apply.
Most insurance companies that operate on reimbursement basis, offer direct
settlement when it comes to planned inpatient treatment. Some have a
network for inpatient treatment. The insured should obtain
preauthorization from the insurance company by notifying them before the treatment.
It’s only natural for you to feel anxious at a time of ill-health. We will do everything we can to help make your claim as simple and straightforward as possible.
Step-by-step guide:
Outpatient Treatment :
Step 1 of 4
Carry your claim form and your insurance card whenever you visit the doctor. Alternatively, copies of claim form could be kept in your hospital file and used whenever you visit the doctor.
Step 2 of 4
Complete your part of the claim form. Claim forms usually carry clear directions. If you need any clarification, give us a call on the numbers mentioned below and the customer care executive will guide you through the procedure. If you do not have a claim form, we will send it to you.
Ask your doctor or medical practitioner to complete his part of the claim form. He should sign it and put the clinic / hospital stamp. Send them to us along with the original invoices / receipts, original prescription, medical reports and other information, if any about the treatment.
Step 4 of 4
The eligible claims will be settled by the insurance companies as soon as possible.
Inpatient Treatment:
Direct Settlement
For planned / elective In-patient treatment, clients can go for direct settlement of the bills within the network, that is the Insurance Companies settle the bills directly to the hospital.
Step 1 of 4
Inform us at least a week before the probable date of admission. In case of emergencies, contact the insurance desk in the hospital at your earliest.
Step 2 of 4
Get the claim form filled by your attending Physician/Specialist.
Step 3 of 4
Send us the completed claim form, contact details & address of the hospital, medical report from your treating doctor and the estimated treatment cost.
Step 4 of 4
The eligible treatment costs will be settled by the insurance companies to the hospital directly.
Reimbursement :
You can go for the treatment either within or outside the network.
Step 1 of 4
Carry your claim form and your insurance card whenever you visit the doctor. Alternatively, copies of claim form could be kept in your hospital file and used whenever you visit the doctor.
Step 2 of 4
Complete your part of the claim form. Claim forms usually carry clear directions. If you need any clarification, give us a call on the numbers mentioned below and our customer care executive will guide you through the procedure. If you do not have a claim form, we will send it to you.
Ask your doctor or medical practitioner to complete his part of the claim form. He should sign it and put the clinic / hospital stamp. Send them to us along with the original invoices / receipts, original prescription, medical reports and other information about the treatment.
Step 4 of 4
The eligible claims will be settled by the insurance companies as soon as possible.
