Have you ever been shocked by a hospital bill that seems too high to handle? You’re not alone. At Raja Hospital, we understand that dealing with health issues is tough enough without worrying about how you’ll pay for it. That’s why we’re here to guide you through the health insurance claims process—a simple solution that can help manage those daunting bills.

What is a Health Insurance Claim?

What is a Health Insurance Claim? Raja Hospital

A health insurance claim is a request made to your insurance company to cover medical services you’ve received or to reimburse you for payments you’ve made out of your pocket. Essentially, it’s how you tell your insurer, “Hey, I got the medical care I needed, and I’d like you to take care of the bills, please!

Types of Health Insurance Claims at Raja Hospital

There are mainly two types of health insurance claims:

  1. Cashless Claims: These are the most convenient. At hospitals like Raja Hospital that are part of your insurer’s network, the hospital directly bills your insurance provider. You don’t have to pay upfront; your insurer settles the bills with us.
  1. Non-Cashless/Reimbursement Claims: If you receive treatment at a hospital not in your insurer’s network or prefer paying through your pocket initially, this type is for you. You pay the bills, then claim reimbursement from your insurance company.

Documents Required to File a Health Insurance Claim

Documents Required to File a Health Insurance Claim.

These documents could be very helpful to you at the moment you are ready to place your claim; this will help smoothen and expedite the process. Normally, the following is required:

  1. Completed Claim Form: This is essential and must be filled out accurately.
  2. Medical Bills and Receipts: All original bills and receipts were paid during the treatment. Medical Reports: Any reports that detail the treatment, including diagnosis and type of care received.
  3. Discharge Summary: If you were hospitalized, a discharge summary from the hospital is necessary.
  4. ID proof: A copy of your ID proof (like an Aadhaar card, CKYC, or a Driver’s License) is needed to be uploaded, usually to authenticate the identity of the policyholder.
  5. Policy Paper/Health Card: Always carry your documents while visiting the hospital.

How to Claim Your Insurance at Raja Hospital?

Whether it’s understanding what your policy covers or dealing with the aftermath of a claim rejection, we’re here to help. After all, we believe in taking care of both your health and your peace of mind!

For Cashless Claims:

You have to carry all the required Documents like ID proof, Policy Paper, Health Card, etc.

During Admission

At the time of admission, our hospital executive will send the information below to your insurance company within 24 hours for initial approval:

  • Pre-Autherization Form which includes complete information about the patient, complaints, diagnosis, investigations, estimated length of stay, and estimated cost of treatment.
  • Health card, ID card, and address proof of patient.

Insurance companies generally take 4-8 hours maximum to approve or raise any query or reject your cashless treatment request.

During Discharge

On the day of discharge, the Hospital executive will send the documents below to your insurance company for final approval:

  • Exact final bill according to the length of stay, medicine, and investigations during the hospital stay.
  • Investigations, medicine bills, indoor case papers, and discharge summaries.

Insurance companies again take 4-8 hours maximum to approve or raise any query for final approval. They may even send their agent to check on you during the cashless treatment for verification purposes.

To learn more about Claim partners go to our website

Reimbursement Through Raja Hospital

Reimbursement Through Raja Hospital

At Raja Hospital, our reimbursement process is designed with your convenience in mind. When you’re admitted to our hospital, you’ll need to pay your bill upfront. But don’t worry, getting reimbursed is straightforward.

For Non Cashless:

If the insurance company/ TPA is not Impaneled, then we help you to get reimbursement.

We provide each and everything including:

  • Hospital Bills
  • Payment Receipts
  • Investigation Reports with Breakup
  • Investigation Report
  • Medicine Bills
  • Discharge Summary

After your discharge, simply fill out the claim form. We take care of collecting all the necessary documents and managing the rest of the process for you. Once everything is completed, you’ll receive your reimbursement promptly. We’re here to ensure that your experience is as smooth and hassle-free as possible. Still you have any queries, the Hospital will always there to help you out.

Rejection Reasons for Claim:

Claim rejections can be frustrating, but they can often be resolved by understanding the reason behind them.

  • Waiting period of Disease: Claims are rejected if they are filed during an initial waiting period after buying the policy, during which certain diseases aren’t covered.
  • Pre-existing Disease: Claims related to diseases that existed before purchasing the policy are often rejected until a specific time (like 2-3 years) has passed.
  • Specific condition not covered: If the condition for which treatment is sought is not mentioned in the insurance policy, the claim will be rejected.
  • Alcohol Influence in Accident: Claims can be denied if the patient was under the influence of alcohol during an accident, as most policies exclude coverage in such cases.

At Raja Hospital, we’re not just committed to providing excellent healthcare but also ensuring that you can navigate through your insurance claims with ease.

Things to Keep in Mind

Know Your Policy Well

Navigating through your health insurance claims can be easy if you remember a few key points:

Notify Early: Always inform your insurer about the treatment as early as possible.

Keep Originals Handy: Always keep original copies of all medical documents; you might need them for verification.

Please Do Not Spoil the Bill: Kindly be careful with your medical bills and other documents. Do not scribble on the bills or spoil them because it has to be neat and legible.

Know Your Policy Well: Understand what your policy covers and what it doesn’t to avoid any last-minute shocks.

Follow-Up: Don’t hesitate to follow up with your insurer if your claim processing is taking longer than expected.


You can confirm your coverage by contacting your health insurance provider directly or going through your policy paper at Raja Hospital to verify what services are included under your specific plan.

Common documents needed include detailed medical bills, a copy of your ID card, Health card/ Policy papers, etc for cashless Claims.

If one is not admitted to a hospital concerned for at least 24 hours for surgery, then the claims will not be accepted.


We take you through the essentials of filing for health insurance claims at Raja Hospital, from understanding the types of claims to following the required steps in getting the expenses covered. Always keep in mind that the claim process might be complicated sometimes; however, rest assured, with our help, you will go through every single step, and with all the friendly staff in the Raja Hospital, you will never be alone on this journey.

Claims processing should be as easy as the given situation can allow: either at the point of going in for a procedure or after receiving care, as the case may be. From Raja Hospital, we believe in more than healing bodies; instead, we believe in soothing peace of mind and helping in the financial aspects of healthcare.

Don’t let the paperwork keep you from getting the care you need. Let us help to guide you through your health insurance claims. Because here, we care for more than just your health; we care for you.