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Step by Step Guide on Making Claims for Health Insurance

The uncertainty surrounding the future is one of the prime reasons why we take Insurance. Deep in our minds, even though we have taken a health insurance policy, we hope that it does not reach a point that we make a claim. 

But what if it happens? Are you at a point where you can make a claim successful? Unfortunately, not all know how they can make an insurance claim. That is why we have decided on this page to help you make a successful insurance claim in the event that the risk covered under the policy happens. Understanding how a health insurance claim is made, though it might seem trivial, is a very important thing. We will explicitly explain the step by step procedures that you need to follow.

Ways to make a claim

There are two ways that an individual can make a claim. These includes:

Through your doctor

If this is the method you will be using, you must visit a doctor recognized by the health insurance firm. This way, the burden of submitting the claim will be left to the doctor, who will then submit it for you. Most probably, they will do it electronically.

Submitting it yourself

Contrariwise, if the health provider is not in the region or not recognized by the insurance firm, you have to go through the hard way of submitting the form yourself and filing the claim yourself. We will put a lot of focus on this method if you are to make claims.

Types of claims

There are two types of insurance claims that an insured can make depending on the policy. These are cashless insurance claims and reimbursement insurance claims.

Cashless insurance claim

 This is very common if the individual has gone for medical treatment in one of the insurance firm’s network hospitals. In this regard, the insurance firms pay all the bills incurred for the treatment. The advantage of this is that you do not need to pay any cash upfront for treatment. Also, the process of receiving the claim is fast as both the doctor and the hospital can communicate easily. The major drawback of this policy is that you might not receive the claim if the hospital is not under the insurance firm provider’s network.

Reimbursement insurance claim

 In order to understand this, we have to understand the key term in this policy. Reimbursement is an insurance jargon that implies that the insured is compensated up to the amount incurred. Note that Insurance is not about making profits. The compensation that you are given only restores you to your initial position.

Under this claim, the person has to pay the policy by themselves before making a claim. This is the ideal policy for those seeking medical help from a non-network hospital or from hospitals from abroad. Here you will only be compensated up to the amount that you incurred.

Unlike the previous one, this one is a tedious process as you have to make a claim you yourself.

What documents do you need to file a claim?

The documents that you submit to the firm are so essential. Sometimes you can follow the due process, but the lack of essential documents could mean that you are not covered. Below are some of the documents that you should ensure that they are available before commencing asking for a claim.

Diagnosis reports

Insurance ID

Consultation papers provided by the doctor


Steps of filing a claim

 Once you have everything that is needed, there is the procedure of making a claim.

Get every document

 As said above, you need all the documents. Do not ignore anything. Avail of all the invoices and the list of serves that the doctor provides you with in addition to their cost. Also, ensure that you indicate the medicines that you were given and their total cost. Provide all the documents in their original form

Get the claim form

 Currently, most insurance firms allow you to make claims online. This means that you can download the claim form online and fill it. 

Head over to the insurance firm provider and download the claim form. The claim should have further instruction on all the documents that are needed and how to fill it. We recommend going through it before anything.

Make copies

 Once you have filled the form and ensured that everything is a field, it’s good to make copies of everything so that you can always avail of a copy of the original form in case anything is lost.

Reviewing before sending

 Like in any writing process, the process of reviewing helps eliminate any errors that might lead to an unsuccessful claim. Go through it to make sure that everything is super accurate. Once you have ascertained that everything is in order, send it. You can ask what period it takes for the insurance firm to be paid.

 How do you make sure that your claim form gets processed smoothly?

Of course, you are not just claiming for the sake of making a claim. That is why there are certain things that you need to do to ensure that it’s processed smoothly. What are they?

  1. Ensure that you are filing a claim form that is related to your benefits plan
  2. If you are filing the claim form manually, ensure that your writings are readable.
  3. Make sure that all the requisite documents and information are provided.
  4. Ensure that the insurance firm covers the treatment claim.
  5. Fill the claim on time. Most firms have a period where you are expected to fill a claim.


To make a successful claim, there is a sequence of steps that you have to follow. Otherwise, you might end up not being compensated. The easiest way to reduce all the hassle is to seek medical attention in the insurance firm’s network hospital. This way, everything can be done for you. But getting seek or injured is always unprecedented. You might get help from a non-network hospital. This means that you have to file the claim by yourself and ensure that everything is availed on the form. If you have to do it yourself, this article has provided you the ultimate guideline that you could ever need.

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