On this page
How health claims usually move
Health claims commonly follow cashless (network hospital) or reimbursement pathways. Timelines, forms and document lists differ by insurer, TPA, policy and hospital processes.
Claims Saathi assists with documentation guidance, coordination and available updates. Claim acceptance and payable amounts are decided by the insurer or TPA.
Cashless pathway — what to prepare
Commonly useful before or during admission
- Policy and insured details ready for the hospital claim desk
- Doctor’s advice / admission notes where requested
- Pre-authorisation request support documents
- Photo ID as required by hospital or TPA process
- Awareness of exclusions, waiting periods and room-rent limits in your policy
Documents commonly requested may include investigation reports, detailed estimates and prior treatment history. Exact requirements vary depending on the insurer, TPA, policy and circumstances.
Reimbursement pathway
After discharge, organise
- Discharge summary (complete)
- Final bill with itemised break-up
- Payment receipts
- Pharmacy and investigation invoices
- Claim form and KYC / bank details via secure channel
- Any query responses requested later
Common mistakes
- Assuming cashless approval means zero patient payable
- Missing pages from discharge summary
- Unclear bill heads that trigger clarification queries
- Delaying responses to document queries
- Sharing medical records on public website forms
Important notes
Exact requirements vary depending on the insurer, TPA, policy and circumstances. This guide is general information only—not medical or legal advice.
Questions to ask
- Is my hospital in network for cashless?
- What documents are needed for pre-authorisation?
- What portion might remain payable by me?
- How should reimbursement documents be submitted securely?
- Who will share the next available status update?
Exact requirements vary depending on the insurer, TPA, policy and circumstances. This guide is general information only and is not medical, legal or claims-decision advice.
Claims Saathi assists with documentation and coordination but does not determine claim approval. Requirements vary based on the insurer, TPA, policy terms and claim circumstances.