What is the process for claiming treatment expenses from two or more health insurance policies

A second or a third health insurance policy comes handy when the first insurance policy does not cover the entire treatment expenses. The first policy may not cover the entire expenses due to various reasons. Read my article to understand common scenarios to use two or more health insurance policies in a claim. This is one of the most complex insurance claim processes because different insurers and third-party administrators (TPAs) follow different protocols and most of them do not follow a defined timeline to process claims. But give rest to your worries and we have the ultimate solution to multi-policy claims. Let’s get started.

File claim from the first policy

This one is a no-brainer. If you got cashless at the hospital, half of your problem is sorted. However, if you are filing reimbursement claim in the first policy, then make sure your claim is completed in all respect and you satisfy the insurer with whatever documentation they require. The goal is to get the claim approved and money settled into your bank account.

File claim from the second policy with whatever documents you have

Now this one is a jugaad, some kind of a hack we developed over time from our own claim experiences. See, the second insurer would like you to claim within a specific timeline. Now if you wait for the first one to process your claim or return your claim documents, it may take a couple of weeks or even months! The best thing to do is to simply fill up the claim form of the second insurer and attach photocopies of discharge summary and hospital bill and submit the claim. Remember to add a cover note informing the second insurer that you are already claiming from the first insurer and once that claim is settled, you will be submitting the claim settlement to them. Till that time, they can hold your claim. What would happen is that the second insurer would accept your claim and it will raise query/additional document request asking for original claim documents. This way you have met the timeline and now your second claim is parked with the insurer.

FYI some insurers may temporarily reject your claim if the query is not resolved within a certain period. They may send you up to three reminder notices for submission of pending documents before sending you a rejection letter. Do not lose heart. Once you get the settlement documents back from the first insurer, you can submit them to the second one with a letter intimating them that the delay in document submission was due to the delay in claim settlement by the first one. This should solve your problem.

Request for return of claim documents and claim settlement letter

Now, this is the hardest step in a multi-policy claim process. But I would try to make it easy for you. Just follow the steps and options I’m enlisting here. If all this doesn’t work, please reach out to SureClaim‘s customer care number or email support.

  1. Call up your first insurer’s customer care (keep trying if you are not able to get through to them in first few attempts). Ask them the process for returning claim documents. Most likely they will give you an email ID to which you must write and ask for the return of the documents. If you are an employee covered in a corporate group insurance policy, find out the email ID of your relationship manager from the insurer or TPA assigned to your company. Mark a copy to that email ID as well.
  2. Please mention in email that you are filing second claim for rest of the expenses from another insurer and that is why you would need original documents and claim summary from the first insurer.

This process is tricky but you can take help from a Insurance Claim Expert and get your paperwork done.