How To Check Health Insurance Claim Status? Complete Guide

Health Insurance plays a major role in anyone's life, it works as a shield of protection at the time of emergency. However, it will be beneficial when the claim settlement ratio of the insurer is high and the claim process is easy and quick. You should know how to file a claim and the steps to check the claim status because doing all these things during your tough times will make it tougher if you do not know the process. In this article, we will tell you how to check your claim status.

How To Check Health Insurance Claim Status?

After filing a claim there is a process of checking your claim status in which you will get to know about the status of your claim. You can check your claim status in two ways, one is online and the other is offline. Online you have to visit the official website of the insurer and offline you can visit the nearest branch.

Different Methods to Check Health Insurance Claim Status

There are two methods through which you can check claim status, one is online and another is offline. Go through the below-given steps to check your claim status:

Steps to Check Claim Status Online

Follow the below-given steps to check your claim status online:

Step 1: Visit the insurer's official website on your search engine.

Step 2: Click on the claim status icon 

Step 3: You will be asked to fill in the required information like policy number, date of birth etc

Step 4: Click on the submit button 

Step 5: Your claim status will appear on the screen

Steps to Check Claim Status Offline

Follow the below-given steps to check the claim status offline:

Step 1: Gather all the documents you have related to your health insurance.

Step 2: Visit the nearest branch of the insurance company from whom you have purchased your health insurance.

Step 3: Ask the branch manager or assistant branch manager to provide you with claim status of the claim you have filed.

What Are The Different Stages of Claim Status

When you file a claim it goes through several stages before it's fully processed. Here you will get to know the process and level at which your claim stands. Go through the information for more knowledge about the claim process.

1. Claim Submission

This is the first stage in which the insurance company receives your claim. This is the first step in the process, irrespective of whether you have filed a reimbursement claim or a cashless claim at a network hospital.

2. Claim Review or Inquiry

The insurance company reviews your claim at this stage, checking over all the information, paperwork, and bills. They look into coverage for treatments, policy coverage, and other important details.

3. Claim Processing

After the required paperwork is in order, the claim proceeds to the processing stage. Using the policy terms, approved treatments, and the claimed amount as a basis, the insurer will verify the claim. They figure out the amount payable if everything is in line.

4. Claim Approval

At this point, your claim has either been fully or partially approved by your health insurance company. It's possible that you'll get a notification that your claim has been accepted and that you'll soon get your money.

5. Claim Rejection

However, not every claim gets approval. The claim could be rejected if it fails to meet the policy's requirements. Incomplete paperwork, treatments not covered by the policy, and going above the coverage limit are typical reasons for rejection.

6. Payment Disbursement

The insurance company pay out the claim after it is approved. They pay the hospital immediately after filing cashless claims. The money for reimbursement claims is transferred into the bank account you have on file.

FAQs

Ques 1. What information do I need to check my claim status?

Ans. To check the status of a claim, you usually need to know your policy number, claim reference number, and personal details such as your name or birthdate.

Ques 2. How long does it take for a health insurance claim to settle?

Ans. Processing times can vary, but most claims take between 7 to 30 days. For cashless claims, it could be faster as the hospital and insurer coordinate directly.

Ques 3. What does it mean if my claim is “pending”?

Ans. A "pending" status generally indicates that the insurer is currently examining or handling your claim. It may be called for more proof or documentation.

Ques 4. Can I track the status of a reimbursement claim?

Ans. Yes, reimbursement claims can be tracked in the same way as cashless claims via the online portal, mobile app, or customer service.

Ques 5. How will I know if my claim is approved?

Ans. When your claim is accepted, you will get the update via email, SMS,  or the app. Additionally, you have access to your account's status.