Detailed Information on Medical Records Required for Mediclaim

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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