ICICI Lombard Health Insurance Claim Settlement

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ICICI Lombard health insurance's claims settlement is a user-friendly and easy process you can opt out of for keeping your family healthy.

It is a simple, hassle-free process which can be completed in easy online mode. 

The insurance company takes pride in its high ICICI Lombard health claim settlement ratio statistics of  96.93%, which is evident from its quick and easy claim settlement procedure for health insurance, which is supported by a huge number of network hospitals on the database of health ICICI Lombard facilities. In the ICICI Lombard claim settlement process there are two options: Cashless and Reimbursement.

The Claim Process for Cashless Treatment for  ICICI Lombard Health Insurance Claim Settlement

The ICICI Lombard health insurance claim settlement provides cashless treatment benefits, which will help you to cope with the medical emergency and stressful situations, and no need to give money for your medical bills, or the expenses incurred during the hospitalisation, rather you can take care of your family in those critical circumstances. ICICI Lombard health insurance will pay the insured expenses once you submit the claim and you have to inform the company regarding your admission. You have access to almost  11,700+ network hospitals which is under their partnership, where you can access cashless treatment. 

The high ICICI Lombard health claim ratio assures you have a quality treatment process. The procedure of the ICICI Lombard health insurance claim settlement can be done in two exclusive ways, planned and emergency. The only major difference between the two is the difference in the time slot when you have to inform the company regarding your admission. You have informed the company within 24 hours of emergency hospitalisation, and you have to inform the company within 48 hours if it is a planned hospitalisation. The  process of cashless ICICI Lombard health insurance claim settlement is as follows :

  1. You have to keep details of an ICICI Lombard network hospital in the city or nearby where you want to receive cashless ICICI Lombard health insurance claim settlement. You can also keep a list of all the network hospitals as per your requirement for future reference.
  2. You have to take the cashless ICICI Lombard card or the insurance number and member ID while attending a network hospital.
  3. You have to visit  the hospital's insurance desk and place the member ID card or policy number with the executives .
  4. After your identity proof is checked, the hospital will give you an update on the pre-authorisation form.
  5. You have to fill out the hospital's pre-authorization form completely and accurately.
  6. The pre-authorization request will be delivered to ICICI Lombard health insurance company when the insurer was informed and the form was filled in properly.
  7. The insurance team at ICICI Lombard health insurance informs the policyholder and the hospital of the acceptance or denial after assessing the claim information received from the policyholder.
  8. After the approval, the claim bills are directly settled by the  ICICI Lombard health insurance company in a cashless manner.
  9. If there is a rejection by any means,  the policyholder is responsible for paying the bills, in that case, the ICICI Lombard will cover the medical costs promptly after the acceptance.

The Cashless Claim Procedure After Admission

The cashless claim process in the network hospital is a simple process to follow, you just have to submit all the necessary supportive original documents to the hospital help desk for the ICICI Lombard health insurance claim settlement, and the hospital will forward it to the TPA in charge of the company. The claim needs to be reviewed and approved by the hospital authority for immediate cashless treatment by any means. The hospital authority or the TPA in charge may guide you to submit any additional requirements as per any additional change of sum incurred as per need. 

ICICI Lombard health insurance claim settlement will be finally processed when the company TPA in charge will forward your invoice details and the discharge certificate to the company. 

The company will accordingly ensure the complete payment as per your insured claim based on policy excluding some expenditures prohibited by law. The entire process will need just 15 days for the overall settlement of the claim if all documents are original and approved accordingly. 

List of Documents Required for ICICI Lombard Health Insurance Cashless Claim

The required documents for the cashless claim are as follows:

  1. The prescriptions of the doctor, case history details
  2. Original investigations reports and laboratory reports
  3. The original pharmacy bills
  4. The FIR or post-mortem report if any
  5. The operation details, surgeon prescription with details purchase of any medical equipment
  6. The hospital discharge reports
  7. The cancelled cheque or NEFT details
  8. Your coverage and insurance details
  9. Your name, address, and contact information for the hospital records
  10. Your photo id proof
  11. The name and contact of the treating doctor
  12. The case history or original papers of any lifestyle habits need to be taken care of
  13. The two important dates to be kept into account are the date you were admitted to the hospital and the date you were discharged
  14. The hospital may need additional requirements as per their need for claim settlement

How to Check  ICICI Lombard Health Insurance Policy Claim Status?

The ICICI Lombard health insurance company gives some lucrative health insurance plans to its clients to cover the medical related costs, it provides the major claim procedures in easy online mode, with a claim settlement ratio of 96.93%, which clearly states that you can have a safe healthy life with  ICICI Lombard health insurance. The status of the policyholder can be checked from the website of the  ICICI Lombard health insurance for any particular claim for the insured policy. You can always monitor a claim, and submit the claim notification for your insured policy.

The following instructions are the easy steps through which you can check the policy claim status of the ICICI Lombard health insurance claim settlement from the website in the online process

The Online Process for  ICICI Lombard Health Insurance Claim Settlement

You have the option of offline or online claim status checking. Web-based process. Follow the instructions listed below to verify the status of a claim online:

  • Visit the claim status section of ICICI Lombard's official website.
  • Type in the necessary information, such as the claim number or AL number, and click "Search."
  • Following that, you may access the provided web page to see the status of your claim.

The Offline Process for  ICICI Lombard Health Insurance Claim Settlement

There are options besides the online process also, in case of any inconveniences online mode for checking the status of your claim, you may phone their customer care service, helpline number at 1800 2666 (Available 24 x 7) or you can put an email customersupport@icicilombard.com  for getting in touch with them for the claim status.  You can also visit the nearest branch of the  ICICI Lombard health insurance and meet the customer care executive for the current status of your insured claim, you have to carry the relevant documents of yours for that, like policy ID, card number, intimation number, or others if required by the executives.

The Claim Process for Reimbursement Treatment for  ICICI Lombard Health Insurance Claim Settlement

Filing a reimbursement claim requires some action on your part, as opposed to a cashless claim. No matter if you received treatment from a network hospital or a non-network hospital, you are still eligible to file a reimbursement claim with ICICI Lombard health insurance claim settlement.

Here are the steps for health insurance reimbursement claim procedure:

  1. To notify ICICI Lombard of your hospitalisation, you can contact our toll-free number, 1800 2666, send an SMS message with the keyword "HEALTHCLAIM" to the number 575758 (cost: $3 per SMS), or contact them at iHealthcare@icicilombard.com.
  2. Place all the documentation in chronological order once you have paid the hospital. As you go from your patient record, medical reports, and hospital bill, start with the initial bills for your doctor's visit, X-ray, and other medical charges. You can also submit your medical expenditure invoices with the company if they were incurred between 30 and 60 days prior to your hospital stay. You might wish to go to a clinic in your area if you need to be hospitalised either on a scheduled or emergency basis. If the physician treating you is affiliated with a certain hospital.
  3. The claim form must then be downloaded from the website. Fill out the information in sections A, C, and D on paper. The hospital or your treating physician must complete section B. After that, sign the claims form and have your treating physician sign it as well. Then email it to the company with the necessary documentation.
  4. They'll review your health insurance claim request as soon as all of the papers have been successfully submitted. Depending on the scope of your insurance coverage, your claim may be accepted or rejected. In some circumstances, the company might need extra information from you in order to complete your claim more quickly.
  5. ICICI Lombard will deposit the claim money into your checking account if the claim is authorised. If your claims are rejected, we'll let you know why in writing.

List of Documents Required for ICICI Lombard Health Reimbursement Claim

These are the documents required for your ICICI Lombard health claim settlement ratio:

  1. Complete claim form
  2. Original and final hospital bills, as well as any additional costs
  3. Daycare/original discharge summary
  4. Initial investigation reports, including those for the ECG, CT, MRI, USG, and HPE
  5. Original payment receipts and any further documents proving payment for invoices
  6. Original prescription bills
  7. Photocopies of prescriptions from doctors
  8. The original invoice or implant sticker
  9. Photocopies of the following documents are required: Consultation paper; indoor case paper;
  10. Photocopies of age proof (driver's licence; PAN card; passport; aadhar card);
  11. KYC (copy of ID proof; residence proof; and two passport size photos);
  12. EFT (copy of cancelled check; self-attested ID proof; and bank attested copy of passbook with IFSC code)

Incurred Claim Ratio (ICR) of ICICI Lombard Health Insurance

The ICICI Lombard Incurred Claims Ratio (ICR) demonstrates the company's customer-focused approach to health insurance; it is used to determine how much of the premiums that the firm collects are spent on paying claims. For the fiscal year 2020–21, ICICI Lombard health insurance's incurred claims ratio was 78%. A credible insurance provider has an ICR of at least 50%.

ICICI Lombard Health Insurance Claim Settlement Ratio (CSR)

The Claim Settlement Ratio (CSR) measures how many claims were resolved by a health insurance company compared to how many claims were admitted. One of the most crucial considerations when choosing a health insurance provider is CSR. It reveals how successfully the business resolves disputes.  ICICI Lombard health claim settlement ratio is a potential insurer since it consistently has a high claim settlement ratio. The firm has a high claim settlement ratio since it settles three claims per minute (CSR). The claim settlement ratio for ICICI Lombard health insurance for the 2019–20 fiscal year was 96.93% in less than 3 months and 1.79 in 3-6 months. 

ICICI Lombard Health Insurance Claim Settlement FAQs

  • 1. How is ICICI Lombard health insurance claim settlement ratio determined?

    The following formula may be used to get the ICICI Lombard health insurance's claim settlement ratio: claim settlement ratio = (total number of approved claims/total number of received claims) times 100.

  • 2. How can I make an ICICI Lombard cashless claim?

    Get admitted to a network hospital, present your Identity card at the clinic desk, complete the pre-authorization form, and submit it to make a cashless claim. This will terrify the insurer regarding admittance. When your application has been accepted, you may start the cashless procedure, and ICICI Lombard will immediately pay all of your invoices.

  • 3. How can I submit a reimbursement claim for one of ICICI Lombard health insurance's health insurance plans?

    You must take the actions outlined below in order to submit a reimbursement claim under the ICICI Lombard health insurance policy:

    • Enter a non-network hospital for treatment
    • Take advantage of the necessary care and pay for it out of your own money
    • Send the insurance company the invoices and paperwork
    • The insurance provider will reimburse you for the costs spent if the claim is submitted in line with the terms and conditions of the health plan
  • 4. What can I do if my ICICI Lombard claim is rejected?

    You can still look for a resolution if your insurance denies your claim after you've submitted one. Examine your insurance documentation once more to get the rationale for the claim denial. Following are some actions you can take:

    • Call the ICICI Lombard help desk or the TPA and give the outstanding information if your claim was denied owing to missing information. Keep a log of every conversation you have with the insurance for future reference.
    • If your claim has been denied because of incomplete paperwork, submit any outstanding paperwork within the allotted time window. If your TPA assisted you in filing the claim, use their support to resubmit the missing documentation.
    • If a claim is denied because treatment was medically unnecessary, this can happen. You can give precise medical information in this situation by offering a letter of support from your physician, an expert opinion, or even health research. In this situation, you may appeal the refusal of your healthcare insurance claim.
    • If your claim is still rejected after performing the aforementioned actions and you're not happy with the rationale, you can submit a formal appeal to the Ombudsman. Within 30 days after getting an answer from the insurance carrier, you must take this action.

    Health Booster, Arogya Sanjeevani Policy, Corona Kavach Policy, and Personal Accident Insurance are just a few of the health insurance plans offered by ICICI Lombard. These policies give consumers the much-needed financial support they require in case of medical crises.

  • 5. What is the deadline for notifying ICICI Lombard health insurance of the hospitalisation?

    You must notify ICICI Lombard health insurance a minimum of one or two days in advance of any planned hospitalisation. In contrast, you must notify the insurance company of an emergency hospitalisation within 24 hours after admission.

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