Worried about Corona virus spreading in India? Buy Health Insurance and get coverage now. View Plans

Oriental Health Insurance Claim Settlement

For a lot of health insurance buyers, the single most important factor is not the network of hospitals, or even whether the brand is heavily advertised, but the claim settlement ratio. Oriental Health Insurance boasts a high claim settlement ratio of nearly 94% which means that the insurance company is rejecting a handful of questionable or bogus claims, but is settling claims for the large part. The Oriental Insurance claim settlement ratio is thus a big confidence booster for potential health insurance buyers and the reason why they are likely to choose the brand over others. 

If you are considering purchasing a health insurance policy from Oriental Insurance, it is a good idea for you to wrap your head around the claim settlement process. In fact, this research should always be conducted before buying insurance or immediately after getting your hands on your policy. This practice of preparedness will be very handy should a health emergency actually strike – when you are unwell and additionally already stressed about your health, in all probability, it is not going to be possible for your brain to register new information, especially about something like a claim settlement process. Imagine your mind swimming with information from doctors. You might want to grab your phone and google things that they are saying, but finding out about your insurance claim process at this time might not be possible. Not to mention that you should be prepared beforehand. 

Well, fortunately you have chanced upon the perfect resource for your research – in , article we will guide you on the Oriental Health Insurance Claim Settlement process. 

With any insurance company, there are two routes to claim settlement. 

  1. The cashless route, which is preferred by many when their funds are low or to avoid the uncertainty of whether or not a claim will be settled in the future 
  2. The reimbursement route, which is preferred when coordination with the hospitals insurance claim department is not possible or when there is no network hospital that is close enough at the time when the health emergency strikes.

In both cases, the insurance company goes through your information with equal thoroughness to evaluate the validity of your claim. The difference is that in cashless hospitalisation, it is the hospital who coordinates on your Oriental Insurance Claim Status and all the payments go directly from the insurer to the hospital. In case of reimbursement, however, you get your funds after you have paid up at the hospital, gotten discharged, have made an application at Oriental Health Insurance and gotten an approval on the same. 

Cashless hospitalisation with Oriental Health Insurance 

Step 1: preparation

As soon as a health emergency strikes, get hold of your card and also be sure to find a network hospital 

Step 2: contact

Contact Oriental Insurance and intimate them that you are getting hospitalised or else, if you have lead time, let them know that you intend to get hospitalised. If you have time in hand, you can try to apply for cashless hospitalisation with that much more ease. 

Visit the network hospital with your health insurance card and a proof of your identity.

Step 3: paperwork 

Collect the pre approval forms and complete your paperwork . 

Step 4: over to the insurer 

Now the Oriental Insurance will go through your documents and forms; evaluate your claim validity and revert to you with your Oriental Insurance claim status. 

Reimbursement claims with Oriental Insurance 

Step 1: Check in 

  • Get yourself admitted to the hospital
  • Inform Oriental Insurance about your hospitalisation while stating your policy number or card ID number 

Step 2: Paperwork 

  • From the moment you are admitted, the hospital will begin giving you bills that you will pay and in return, you will receive receipts. Maintain a folder or envelope in your hospital room or ward where you can collect all these bills and receipts
  • You will also get prescriptions on the basis of which you will purchase medicines from the pharmacy  – maintain copies of these too 
  • Consultation bills from your doctors and their certificates detailing diagnosis and treatment and all diagnostic test copies should be added to your little pile of proofs 
  • Lastly when you get discharged be sure to get a completed discharge form and bills and receipts for everything you pay. 
  • Download and fill up the reimbursement claim form and get any signatures necessary from the hospital 
  • Make an application with original bills and receipts, tests and certificates, sign it and send it to Oriental Insurance. Do maintain copies of tests and certificates for your own reference.
  • Oriental Insurance has a dedicated claim settlement team that will evaluate your claim and settle it as per the terms and conditions of your policy. 

Document requirements for reimbursement claims 

Before you pay your final bill at the hospital, be sure that you get all your paperwork in order for your insurance claim. Here is a checklist that can help you prior to checkout: 

  • Have you collected all original bill copies?
  • Have you collected receipts for all payments made?
  • Have the doctors returned all original tests and X-rays etc to you?
  • Have you received certificates detailing treatment by all the doctors and specialists involved?
  • Have you received certificates regarding surgery conducted if any?
  • Have you got copies of all your prescriptions? 
  • Hospital discharge paperwork and bill settlement confirmation paperwork. 

Additionally, you need to add the following to your application

  • Claim form – completed and signed 
  • Policy photocopy
  • Premium receipt photocopy
  • Photo ID copy 
  • Copy of claim intimation made to the Oriental Insurance when you were admitted 

Today health insurance claims are a quick, easy and convenient process. 

FAQs

How long does claim settlement usually take?

You can expect settlement in about 30 days in most cases.

What happens if I don’t get cashless hospitalisation?

If there is insufficient information to to support a cashless claim, you should still ensure you get the requisite treatment and then complete your forms, paperwork and documentation to apply for reimbursement.

How many hospitals does Oriental Insurance own?

Insurers do not own hospitals, but partner with them for cashless hospitalisation. These hospitals are then known as empaneled hospitals. The hospital does receive money from the insurance company for your hospitalisation and as such there is a coordination process. Oriental Insurance has a network of over 4300 hospitals.

Why has a nearby hospital been removed from the network hospitals list? Is it a printing mistake?

Insurance companies have partnerships with empaneled hospitals. You can check with Oriental Insurance to be sure, but it is most advisable to go only with network hospitals as per the most updated list available on the Oriental Insurance website.

Click to rate this!
[Total: 0 Average: 0]