Detailed Information on Medical Records Required for Mediclaim
* Discharge Summary
This is the most important document. It is provided when a patient is discharged from the hospital. It contains the following details
* Patient's name, age, and date of admission and discharge.
* Reason for hospitalization (diagnosis of the illness).
* Details of the treatment given, such as surgery, medications, etc.
* Advice on future care and which medicines to continue.
* Original Bills and Receipts
To support the mediclaim application, original bills and receipts for all expenses are required. This includes:
* Hospital bills, which detail room rent, operation theatre charges, nursing charges, etc.
* Bills for medicines and medical supplies.
* Bills for laboratory and diagnostic tests.
* Receipts for doctor's fees.
* Prescriptions
All prescriptions written by the doctor must be submitted. This includes prescriptions for:
* Medications.
* Laboratory and diagnostic tests.
* Any surgery or special treatment that was recommended.
* Laboratory and Diagnostic Reports
Reports of all tests conducted during treatment must also be submitted. This includes reports for:
* Blood tests (CBC, blood sugar, liver function tests, etc.).
* X-ray, MRI, CT scan, ultrasound, ECG, etc.
* Pathology reports, if a biopsy was performed.
* Policy Document and Claim Form
Your medical insurance policy papers and a properly filled and signed claim form are also necessary. The claim form can be downloaded from the insurance company's website or obtained from an insurance agent.
* Other Documents
In addition to the main documents mentioned above, some other documents are also required:
* Patient's photo ID and address proof (Aadhaar card, PAN card, passport, etc.).
* ID card issued by the hospital at the time of admission and discharge.
* Parent's photo ID if the patient is a minor.
Important Notes:
* Original Documents: For a reimbursement claim, it is mandatory to submit the original copies of all documents.
* Keep a Copy: Before filing the claim, keep a photocopy of all documents for your records.
* Time Limit: Every insurance company sets a specific time limit for filing a claim (generally 30 to 90 days after discharge). It is essential to file the claim within this period.
If a Query Arises in a Mediclaim Claim:
* Understand the Query
* Reason for Query: First, carefully read why the insurance company sent the query. Reasons may include:
* Lack of Documentation: A necessary document, such as an original bill, discharge summary, or a specific test report, might be missing.
* Unclear Information: A detail in the bill or doctor's prescription may be unclear.
* Gather Documents: After understanding the query, immediately gather the documents requested. If you don't have them, try to get them from the hospital or the doctor.
* Respond in Time
* Time Limit: Insurance companies give a time limit to respond to a query (generally 7 to 15 days). Failing to respond within this period may lead to the cancellation of your claim, so a prompt response is crucial.
* Provide Accurate and Clear Information
* Accuracy of Information:
When responding to a query, provide only the information and documents that have been requested.
* Specific Documents:
* If a document is missing, send its original copy or a clear photocopy.
* If the details on a bill are unclear, obtain and send a Clarification Letter from the hospital.
* For a query about a medical reason, get a Clarification Note in writing from the doctor.
* Contact Directly
* Contact the Insurance Company: If you have difficulty understanding the query, directly contact the insurance company's claims department. You can call their helpline or send an email.
* Keep a Copy of All Documents
* For the Future: Keep a photocopy of all documents you send to the insurance company for future reference.
In short, when a query arises, don't panic. Calmly understand the reason and immediately send the required documents. This will help resolve your claim quickly.
Have you ever needed documents for a mediclaim?
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