When you file a claim for a hospital bill, the time taken for claim settlement depends on the type of claim you opt for—Cashless or Reimbursement.

In simple terms:

• Cashless Claims (hospital directly settles with the insurer) are usually processed within 3 hours of discharge.
• Reimbursement Claims (you pay first, insurer reimburses later) take 7-21 days, depending on documentation and processing speed.

This guide explains everything you need to know to ensure a smooth & fast claim settlement process!

1. How Long Does It Take to Get a Cashless Claim?

What is a Cashless Claim?

A cashless claim means you don’t have to pay the hospital bill upfront—your insurance company settles it directly with the hospital.

Time Taken for Cashless Claims:

• Planned Hospitalization: Approval within 1 hour of pre-authorization & claim settled within 3 hours of discharge.
• Emergency Hospitalization: Claim approval within 24 hours, final settlement within 3 hours of discharge.

Example:

If you’re admitted at 10 AM, the hospital will send the pre-authorization request to the insurer.

• By 11 AM: Insurer approves the claim.
• On Discharge Day: Final bill is settled within 3 hours after submission.

Steps for a Cashless Claim (Planned Treatment)

1. Inform the Insurer: Notify your insurer 48 hours before admission.
2. Submit Pre-Authorization Form: Hospital sends it to the insurer.
3. Approval: The insurer approves within 1 hour.
4. Treatment & Discharge: The final bill is sent to the insurer.
5. Settlement: The insurer clears the payment within 3 hours.

Steps for a Cashless Claim (Emergency Hospitalization)

1. Inform the Insurer: Within 24 hours of hospital admission.
2. Hospital Sends Claim Request: Insurer starts verification.
3. Approval: Takes around 1-3 hours.
4. Final Payment: Cleared within 3 hours of discharge.

Key Takeaway: Cashless claims are settled within 3 hours of discharge, making it the fastest and easiest way to get your hospital bills covered.

2. How Long Does It Take to Get a Reimbursement Claim?

What is a Reimbursement Claim?

A reimbursement claim means you pay the hospital bill first, and the insurer reimburses you later.

Time Taken for Reimbursement Claims:

• 7-14 days (If all documents are correct).
• Up to 21 days (If additional verification is required).

Example:

If you’re discharged on 1st August and submit all documents the same day, you can expect your claim settlement between 7th - 14th August.

Steps for a Reimbursement Claim

1. Inform the Insurer: Within 24 hours of admission for emergency cases, 48 hours for planned treatments.
2. Pay the Hospital Bill: Collect original bills, discharge summary, and prescriptions.
3. Submit Claim Documents: Within 7-30 days after discharge, depending on insurer guidelines.
4. Insurer Verification: Takes 7-14 days if all documents are correct.
5. Payment: If approved, the insurer transfers the amount to your bank account.

3. What Affects the Claim Settlement Time?

Even though insurers try to settle claims quickly, some factors can delay the process.

Common Reasons for Delays:

Incomplete Documents – Missing bills, prescriptions, or discharge summaries.

Wrong Bank Details – Incorrect IFSC code or account number can delay reimbursement.

Third-Party Administrators (TPAs) Involved – Some insurers use TPAs, which add extra processing time.

Hospital Delay in Sending Documents – Some hospitals take longer to send final bills to insurers.

Solution: Double-check all documents before submitting & follow up regularly!

4. How Can You Get Your Claim Processed Faster?

For Cashless Claims:

• Choose a network hospital for faster approval.
• Inform your insurer in advance (for planned treatments).
• Ensure all documents (ID proof, policy details, doctor’s prescription) are ready before admission.

For Reimbursement Claims:

Submit all documents correctly (hospital bill, discharge summary, prescriptions, etc.).

Double-check your bank details before submitting the claim.

Follow up with the insurer every 2-3 days to track your claim status.

Pro Tip: Some insurers offer priority processing for long-time customers—ask about fast-track claims!

5. What If Your Claim Gets Delayed or Rejected?

Delayed Claim?

• Call the insurer and ask for a status update.
• Send an email with your claim reference number.
• If no response within 30 days, file a complaint with IRDAI Grievance Redressal.

Claim Rejected?

• Find out the reason: Missing documents, policy exclusions, incorrect information.
• Appeal the decision: Submit a grievance request with corrected documents.
• If still denied, escalate to IRDAI (IRDAI Grievance Redressal System).

Key Takeaway: 90% of claims get processed on time IF documentation is correct. Always track your claim status & escalate if needed.

Final Takeaways

1. Cashless claims are settled within 3 hours—always choose network hospitals!
2. Reimbursement claims take 7-14 days—submit complete documents to avoid delays.
3. Common reasons for delay: Missing documents, TPA involvement, wrong bank details.
4. Track your claim status & escalate if needed—don’t wait if your claim is stuck!

Final Tip: To get your claim processed quickly, be proactive, submit accurate documents, and follow up regularly!