What is a Reimbursement claim?
In a reimbursement claim you pay the hospital yourself, then submit bills and documents to your insurer to get the covered amount back. It is how you claim at non-network hospitals, or when cashless was not used, and it pays only the admissible portion of your bill.
How reimbursement works
You settle the hospital bill from your own pocket and collect the discharge summary, itemised bills, payment receipts, investigation reports and prescriptions.
You file these with the insurer or TPA within the policy's claim window. They assess the admissible amount against your cover, apply any deductions, and pay the balance to you.
Why the payout can differ from what you paid
Reimbursement pays the admissible amount, not necessarily what you spent. Non-payable items, co-pay, room-rent-linked proportionate deductions and sub-limits are removed first, so keep every document to support the claim.
Example
You are treated at a hospital outside your insurer's network, pay the bill, and submit the documents. The insurer reviews them and refunds the covered amount after deducting non-payable items and any co-pay.
Common mistakes
- Missing the claim-submission deadline stated in your policy.
- Losing original bills or the itemised breakup, which insurers need to assess the claim.
- Not intimating the insurer about the hospitalisation within the required window.
Frequently asked questions
How long do I have to file a reimbursement claim?
Each policy sets its own intimation and document-submission windows (often counted in days from admission or discharge). Check your policy wording and file as early as possible.
Can I claim reimbursement after using partial cashless?
Yes. If cashless covered only part of an admissible cost, you can usually claim the remaining eligible amount by reimbursement with the balance documents.