Saif Ali Khan’s Incident: Health Insurance Claim Process for Emergencies

Actor Saif Ali Khan is currently recovering from a serious knife attack that occurred during a break-in at his Mumbai residence. The actor, who was rushed to Lilavati Hospital for treatment, is covered under a health insurance policy with Niva Bupa. His insurance claim, amounting to Rs 35.95 lakh, has been partially approved with Rs 25 lakh granted for cashless treatment.

In response to the incident, Niva Bupa confirmed that the remaining balance of the claim will be processed once the final medical bills are submitted. The insurer expressed concern over the unfortunate event and extended their best wishes for Khan's recovery. "As part of our commitment to our policyholders, we approved the pre-authorisation request for cashless treatment. The final settlement will be made upon receipt of the complete medical documentation," a spokesperson from Niva Bupa stated.

This unexpected medical emergency highlights the unpredictable nature of life and emphasizes the importance of understanding the health insurance claims process. Being prepared in advance can significantly reduce stress and expedite the approval of claims in both planned and emergency hospitalisation scenarios.

In the case of a medical emergency, it's crucial to act quickly. Here's a step-by-step guide to navigating the health insurance claims process for emergency hospitalisation:

1. Upon admission, an advance deposit may be required. Ensure that KYC (Know Your Customer) documents are ready for verification.

2. Immediately inform the insurance company or Third-Party Administrator (TPA) using their helpline.

3. Present the patient’s health insurance card and a valid photo ID to the hospital. The hospital will then send a pre-authorisation request to the insurer or TPA.

4. The hospital will forward medical details, including investigation reports, to the insurer for approval.

5. Pay any expenses that are not covered under the policy. Ensure you collect copies of medical reports and the discharge summary for your records.

If the insurer denies cashless treatment, you can still claim reimbursement by submitting the original bills and medical documents to the TPA after discharge.

When undergoing planned treatment, the claims process can be more predictable. Follow these steps for a smooth experience:

1. Select a hospital within the insurer's network and finalize the treatment plan, admission date, and estimated expenses.

2. Notify the insurer or TPA 48–72 hours before admission. The hospital will send the pre-authorisation request to the insurer.

3. Present the pre-authorisation letter and a valid photo ID during admission. Some hospitals may require an advance deposit, which will be refunded post-discharge or after claim approval. Submit necessary KYC documents as requested.

4. Pay for any expenses not covered under the policy and keep copies of medical reports and discharge summaries for your personal records.-

If treatment occurs at a non-network hospital, the reimbursement process is slightly different:

1. Inform the insurer’s call center within 15–30 days after discharge, as the timeline may vary by insurer.

2. Once notified, you'll receive a claim number to use for all future communications.

3. Complete the claim form and submit original medical bills and documents to the TPA. If additional documentation is required, the insurer will request it within seven days.

4. After verifying all documents, the insurer will process the claim and make the payment within 30 days.