Filing for a reimbursement health insurance claim can be quite a task if you are not used to the process! And this is when your expertise, as a financial advisor can come into play. You can expedite the process of reimbursement claim of your client’s health insurance policy and thus gain him as a customer for life, by simply taking care of the 3 MOST important documents else your customer will not only be unhappy with the experience but also never renew policy from you. In the worst cases, your customer may even spread negative word of mouth on your credibility as an insurance agent which will affect adversely in attracting new clients.
How can you help?
When it comes to documents required, there are three main documents, besides others, which are a must. You should inform your clients about these documents.
Document #1 – Admission advice
What is an Admission Notice?
The first and foremost document that is required is an admission notice where a doctor advice for hospitalization. In case of emergency admission, the doctor-on-call advice admission for the patient to be admitted, post which all admission procedure for the hospital is carried out.
When it is issued?
The document is issued before actual hospitalization takes place.
Why is it required?
The written advice is required by the insurance company to prove the need for hospitalization and thus, it serves as a proof of hospitalization and, therefore, a proof of claim.
Document #2 – Doctor’s Advice for Discharge
What is a Doctor’s Advice for Discharge?
After the client recovers from the illness for which he was admitted, the attending physician needs to advise the hospital for discharging the patient in a fit or a stable condition. He also mentions the follow-up medications and procedure and the subsequent treatment that can be carried on from home.
When it is issued?
It is issued before the discharge of the patient from the hospital which mentions that the patient is stable or fit enough to be discharged.
Why is it required?
The fit certificate signifies that the patient is for discharge and further treatment if any can be continued from home through oral medication.
Document #3 – Discharge Summary/Certificate
What is a Discharge Summary?
A Discharge Summary/Certificate is furnished by the hospital in which your client took treatment when he is discharged from the hospital.
When it is issued?
The Discharge Certificate is issued at the time of discharge from the hospital along with other reports and bills.
Why is it required?
This is another important document which is required in case of reimbursement claims. The document serves as evidence wherein the number of days for which the client was hospitalized is mentioned and the treatment thereafter along with post-hospitalization medications.
Thus, the insurance company can then assess the expenses incurred for the duration of hospitalization as well as post-hospitalization.
Educate your clients about maintaining and submitting these quintessential documents to get their claims processed easily. Some things to remember are–
- There is a complete process of making a reimbursement claim. Read the step-by-step guide for raising health insurance claims for complete information by clicking here.
- All the legal documents should be original.
- If there are multiple reimbursement claims, submit the original documents with one insurance company. Then, get a certified true copy of the documents from the insurance company along with an acknowledgment letter stating that the original documents have been submitted with the insurer. Submit these true copies to another insurance company for getting multiple claim settlements.
- Ensure that the original documents are not soiled or damaged in any way and are eligible to be interpreted.
Once these 3 MOST important documents are taken care of, the other list of documents would be easy to submit like:
- Original bills and receipts
- Claim Form
- Diagnostic test reports, etc.
As mentioned by the insurance company.
A little vigilance goes a long way in getting the claims settled easily and quickly. You should know the important legal documents involved in making a reimbursement claim and help your clients get these documents submitted at the earliest so that the claim is settled quickly.
