How to File a Health Insurance Claim (Cashless & Reimbursement)
The process differs for planned vs emergency hospitalization, and for cashless vs reimbursement — here's how each actually works.
Filing a health insurance claim is straightforward when you know the sequence of steps — most delays and rejections happen because of missing documentation or paperwork submitted too late, not because the claim itself was invalid.
For planned (non-emergency) hospitalization
- Inform your insurer or TPA at least 3-4 days before admission, as required by most policies.
- Confirm the hospital is in your insurer's cashless network, if you want a cashless claim.
- Submit the pre-authorization form (available from the hospital's insurance desk) with your policy details.
- Wait for written pre-authorization approval before admission wherever possible.
- On discharge, review and sign the final bill — the hospital submits it directly to the insurer for cashless settlement.
For emergency hospitalization
- Get admitted first — emergency cases don't need pre-authorization before admission.
- Inform the insurer/TPA within 24 hours of admission, as required by most policies.
- The hospital's insurance desk submits the pre-authorization request retrospectively for cashless claims.
- If cashless isn't approved in time or the hospital isn't in-network, pay upfront and file for reimbursement afterward.
For reimbursement claims
- Pay the hospital bill in full at discharge.
- Collect all original bills, discharge summary, investigation reports, and payment receipts.
- Submit the reimbursement claim form with all documents within the policy's claim intimation window (commonly 15-30 days).
- Track the claim status and respond promptly to any insurer query for additional documents.
Do this — and avoid this
Do this
- Keep every original bill, prescription and report — insurers can reject claims over missing documentation alone.
- Inform the insurer within the required timeline, even if you're not yet ready to submit full documents.
- Ask the hospital's insurance desk for help — most have staff dedicated to cashless claim paperwork.
Avoid this
- Waiting until discharge to start the cashless approval process for a planned admission.
- Assuming verbal confirmation from the hospital means the insurer has approved the claim.
- Losing or misplacing original documents — most insurers require originals, not photocopies, for reimbursement.
Frequently asked questions
Cashless claims are often approved within a few hours for straightforward cases, though complex cases can take longer. Reimbursement claims typically take 15-30 days after all documents are submitted, per IRDAI timelines.
You can pay the bill yourself and file for reimbursement afterward — a cashless rejection doesn't necessarily mean the claim itself is invalid, it can be a network or documentation issue at that specific point in time.
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Need help with a specific claim?
Send us the details on WhatsApp — including any rejection letter — and we'll help you work out the next step.