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MAX BUPA CLAIMS PROCEDURE – EXPLAINED.
27 September 2019
CLAIMS AT MAX BUPA ARE SEAMLESS AND FAST
At the time of medical emergency, we understand that convenience is your only priority. You want to focus on taking care of your loved ones rather than run around for claim. At Max Bupa, we are there for you to ensure that claims are processed as quickly as possible.
Max Bupa has 90% claim ratio which is a reason why people trust us when it comes to claims processing. We’ve been awarded the ‘Most Trusted Health Insurer’ 3 years in a row, so you can stay assured that Max Bupa will be your trusted partner in critical medical emergencies.
We have 4500+ network hospitals, which make the process seamless for you. Our 30 minutes promise means that we respond to every claim request from a network hospital within half-hour. To further make the process hassle-free, Max Bupa settles your claim directly without any TPA involvement.
In case, you are getting treatment in a non-network hospital, you can file a reimbursement claim. Explained below is the claims procedure so that you’re equipped with the right information at the time you need it:
FOR CASHLESS CLAIMS:
Step 1: Get admitted to any one of Max Bupa network hospitals.
Step 2: Use your Max Bupa Health Card or share your policy number with the concerned team at a hospital along with your Passport/PAN card/ Voter’s ID as identification proof.
Step 3: Now, the network hospital will verify your identity for validation and submit the pre-authorization request to us
Step 4: After validation, we review and provide our confirmation to the network hospital by fax and email. We ensure you are also notified of the same through text message and email. Max Bupa will respond to your request within 30 minutes of filing of the claim request.
Step 5: The only activity left to do now is the final settlement of your claim (as per policy terms & conditions) with the hospital after completion of all the necessary formalities
FOR REIMBURSEMENT CLAIM:
Step 1: If you get hospitalized, notify us within 48 hours of admission in our network or non-network hospital. After getting admitted pay the amount directly to the hospital you are in.
Step 2: After you are discharged from the hospital, make sure you have all the relevant documents, invoices, medical reports and discharge certificate with you. We would need the originals of all the mentioned documents to process your reimbursement
Step 3: Send all the documents to us which should be completely filled and signed the claim form. Send your valid ID proof and age proof as well. The claim form is available on:
1. Our website www.maxbupa.com
2. In your policy document
Step 4: After receiving your documents, we review your claim request and accordingly will give our approval, raise a query or reject the same (as per policy terms & conditions)
Step 5: Finally, we will settle the claim (as per policy terms & conditions) and reimburse the approved amount.
FOR OPD REIMBURSEMENTS
In case you wish to reimburse an OPD claim, ensure that you have availed the OPD services from the list of doctors/clinics that have been impaneled within our network only. Retain a copy of a valid bill issued by that doctor or clinic. Given below are the steps:
Step 1: Login to ‘My Account’ and click on ‘Raise a claim’ under OPD tab in the ‘My Account’ section
Step 2: Enter the details in the search section to look for the doctor
Step 3: From the search results, click on ‘Raise a claim’ against the doctor with whom you availed OPD services
Step 4: Fill in the claim form by correctly entering bill details, bank details and uploading the mentioned documents before submitting it
Step 5: Finally, we will review the claim based on the details shared by you. Subsequently, we will approve it, send a query or reject the same (as per policy terms & conditions)
FOR DIAGNOSTIC CENTER REIMBURSEMENTS:
Step 1: To reimburse a diagnostic claim, make sure you have a valid bill copy with you
Step 2: Login to ‘My Account’ and click on ‘Reimbursement claim’ under the annual health check-up tab in ‘My Account section’
Step 3: Complete the claim form by entering correct bill details, bank details and upload the mentioned documents. Then submit it
Step 4: Finally, we will review the claim based on the details shared by you. Subsequently, we will approve it, send a query or reject the same (as per policy terms & conditions)
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