xpertclaim

Claim Preparation by Expert

Expertise | Convenience | Personalized

Rs. 399

About This Plan

In this plan, our Claim Advisor will do a thorough review of your medical documents and bills. Missing documents or documents not in format approved by insurer will be highlighted. Once all supporting documents are in order, Claim Advisor will prepare the claim form and share instructions for attaching all supporting documents to prepare a complete claim.

Advisor will answer all queries of client related to their claim.

If the claim is for unpaid bills from first insurance claim, Advisor will raise the request for settlement letter and claim documents from your previous insurer.

Guidance related to claim submission deadline, submission address and claim tracking will also be provided.

Scope of Service

Document verification

Document Deficiency list

Follow-up with insurer for settlement documents of a previous claim

Claim Form Part-A Preparation

Guidance on claim set preparation

Guidance on claim submission timeline, claim status tracking and submission address

Only one claim is covered in this plan

Out of Scope activities

Claim status tracking

Resolution of queries raised by insurer

Who should buy this plan?

Patients who did not get cashless at hospital

Patients who have unclaimed amount after cashless and having more than 1 insurance policy

Salaried employees who undergo delivery covered in their and their spouse’s corporate policy

Claims of patients with prorata deductions in first claim and need to claim deductions amount in second policy

Documents to be shared with us

Insurance card or policy copy/scan

Copies/scans of investigation reports and related documents

Copies/scans of Discharge summary, hospital main bill, payment receipts, bill breakup

Bank details of main policyholder

Process Flow

Sign-up for service

Share documents through Email / WhatsApp / upload tool

Claims Advisor will be assigned within 24 hours

Document verification

Missing document checklist

Guidance on fixing deficiencies

Claim Form Part-A preparation

Claim submission guidance

FAQs

Fee for xpertclaim plan is not linked to claim amount. Assistance for only one claim will be provided in one sign-up.

Yes, that is recommended. You should claim pre hospitalization and hospital bill together.

Yes, if it is a standalone claim.

Delayed insurance claims are allowed if there is adequate justification for delay.

Absolutely. If expenses for blood bank are as per doctor prescription or discharge summary, those will be covered. If there is balance available in your policy after cashless, you will be able to claim.

You can go for reimbursement claim if your cashless claim has been rejected. Xpertclaim plan is suitable for your claim requirement.

Our responsibility is to prepare your claim as per xpertclaim plan. We do not guarantee claim approval. Claim processing is the sole ownership of insurance company and SureClaim will not be responsible for claim rejection as per policy terms and conditions.

We suggest you sign-up for claimconsult plan. It is more suitable if you want clarifications for your doubts.

We only advise on claim preparation. Collection of missing documents is not part of our scope.

Yes, that is correct. For a single fee amount, one claim will be filed. When you sign-up again, our Claim Advisor will coordinate with your first insurer for settlement documents and prepare your second claim.

Query resolution is not covered in xpertclaim plan. If you need our assistance in query resolution, please sign-up for querysolve plan.

Payment is an insurance claim is dependent on policy terms and conditions and submission of all supporting evidence/documents. Our Claim Advisors take utmost care in advising clients regarding supporting documents required in the claim. However, we are not privy to the complete terms and conditions in your policy. Claim Advisor can give you an estimate of amount which you may receive after claim approval. But it will be no more than an intelligent guess. Your insurer/TPA reserves the right to approve the claim amount as per their claim assessment.

SureClaim offers a free online claim preparation tool – selfclaim. You can use the same if you are interested in preparing claim yourself. Xpertclaim is a plan meant for clients who want assistance from an advisor to prepare claim and get all their claim related doubts answered. Our software and service ensure that you receive higher amount in your reimbursement claim with lesser chances of queries from insurer.

Insurance companies require patient to stay in hospital for atleast 24 hours. Only for daycare procedures like cataract, hernia, piles etc. this criteria is relaxed.

Need for hospitalization, duration of hospital stay and circumstances leading to the death of the patient will decide whether insurance company will accept the claim or not. Claims in deaths due to self-harm, suicide or under the influence of drugs/alcohol may get rejected as these are excluded in insurance policies. Check with your insurer to get more clarity.

We require complete support from claimant to prepare their claim. This means they are required to share valid insurance cover details, medical records, expense details and other critical medical history with Claim Advisor. Our advisors will ask these details from clients on a case to case basis. If this information is not provided completely, it would not be feasible to prepare a proper claim. Advisor will communicate the same to client in such situations.

Insurance industry faces huge losses due to claim frauds perpetrated by certain unscrupulous individuals. SureClaim is a responsible organization working towards fairness in claim procedures. We regularly advise clients to make full disclosure of their medical history to insurers. We do not advise, nor we ourselves undertake, tampering of medical or financial records. In extreme cases, we return service fee to clients who come to us only with the intent to prepare fraudulent claims.

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