Claiming Delivery Expenses Under Health Insurance

Most companies today provide a health cover for employees and immediate family which includes a cover for delivery expenses as well. 

There are a few common misconceptions and bad advices that are floating around related to this process. Hope to clear a few doubts here from my experience.


Common misconceptions related to this process:

1. Going for cashless claim means the hospital will have a free hand in raking up a huge bill as the insurance company has to pay.   
2. Only a single claim can be filed for hospitalization even if it does not cover the complete expenses.

Cashless Claim:

The first and foremost thing that you need to find out is the estimate for a delivery based on the type of room you need at your hospital. You may be surprised to find that some hospitals have different rate when it comes to Patients paying from pocket and those paying via insurance. And here the insurance rates may be on the lower side as they have been bargained by the insurers.

This was my experience with Sitaram Bhartia Hospital and thus if you find there is difference in rates for self pay and insurance claim, then please decide accordingly.

Single Claim:

This is more relevant for couples where both partners are working and have separate insurances from there respective organizations (Or you have a personal policy covering such expenses).

When getting admitted to the hospital please go for claim under the policy which has higher limit for delivery charges so that maximum portion of your bill is adjusted under cashless claim.

You can file a reimbursement claim for the differential amount under your other policy. Please inform the same to the TPA desk at the hospital and ask them for original receipts of the amount paid from your pocket. Also please take stamped copies of Discharge Summary and reports of any tests that may have been conducted during stay at the hospital.

Please do mention while filling the reimbursement claim that it is only for the differential amount which was not covered by your other policy. If the TPA is same for the two policies, you may mention the cashless claim details (Claim Number, Dates etc)

This makes going for cashless claim all the more relevant as otherwise you would only have a single set of bills which you would have to file for the claim irrespective of the fact that complete expenses may not be covered.

Please Note:
A separate bill is raised by the hospital for your baby which includes various check-ups and tests done during hospital stay. In most corporate policies babies are covered from day one. In order to get cashless claim for baby's expenses, try to get your baby's name added to your policy and apply for a claim from hospital itself. If you are unable to get the name added, please gather all original bills and test reports and file a reimbursement afterwards.

The baby's claim is subjective to your policy terms and in case of no complications the insurer may reject your claim, please verify at your end.

In case of any further queries on this please drop a comment or email us at pkh2212@gmail.com