HOW DOES THE CLAIM PROCESS WORK?

India Network Health Insurance claims are handled by Chartis Accident and Health Claims.  A Number of Claims Adjusters are dedicated to handle India Network Health Plan claims along with a supervisor and other staff who provide assistance in resolving claims quickly. 

1. Claim Form - Complete the Claim Form whenever you use the insurance - once for every sickness or fax the PDF Claim Form to (866) 893-5984. This is required even though providers file directly with Insurance. Unless until this form is received your claim from provider will NOT be Processed. Balance due statements from medical providers are not acceptable.  Claimants must submit documentation on itemized insurance billing forms prepared by the medical provider or facility where treatment/services were rendered.  A medical provider will provide a HCFA1500 Form and a facility (hospital) will provide a UB92 form, which can be substituted for Section B of the claim form.   

2. HIPPA Form - Complete this form to Discuss Claims of your visitors

When Insured Get Sick with Cold, Cough, Fever, or some other minor health issue, you have two options:

a) Use the Consult a Doc Program to seek an opportunity to discuss your medical condition with a Board Certified Physician in the United States and get a prescription if needed.   OR

b) Check yellow pages and consult a local physician office for appointment and you are responsible for the deductible amount ($75 or $250 for < 70 years old or $500 per sickness for 70 plus).  Insurance Card should be presented to the provider at the time of service. Complete Section A of the claim form and mail to Chartis A&H Claims Office. If you have paid to the Physician, get Claim Form section B be completed by the physician and mail that along with Section A. India Network soon will have a dedicated fax line to take the claims.

The Claims Office employ a super network of PPOs so that you do not need to worry whether a particular physician is in the network or out-of-network.

c) Medical Emergency: If your policy has -P at the end (ie taken pre-existing condition coverage rider), all emergency care visits are covered irrespective of the reason - whether it is due to a pre-existing condition or a new problem. See the Program Details for the amount available for pre-ex condition emergencies under 100K and 150K program for < 70 years old and 50K policy for 70 Plus years old.

THERE ARE NO PRE-AUTHORIZATION REQUIREMENTS. PLEASE DO NOT WASTE PRECIOUS TIME IN TRYING TO REACH OUR OFFICE. YOU DO NOT NEED ANY ONE PERMISSION TO SEEK EMERGENCY CARE WHEN NEEDED. If you take pre-existing condition rider (offered for all age groups), you are assured of coverage for all medical emergencies, surgeries, hospitalizations.. no exclusions of diseases (amount vary by age and the program chosen - see program link for details).

What does Claims Office Do?

1) VERIFY INSURANCE COVERAGE - Keeping your name, Date of Birth (DOB), passport number as given in the insurance form would help identifying your coverage quickly. If you provide one DOB to India Network, something else to the Physician office then the claim is likely to be delayed. (careful with mm/dd/yyyy format used in the US).

2. SEEK MEDICAL RECORDS FROM ATTENDING PHYSICIAN/HOSPITAL.. In some cases, it is not clear from the claim form and the claims office may request medical records at their own cost to determine benefits. A Check will be issued in the name of Insured Visitor or the Doctor/Hospital within 3 to 6 weeks for all covered claims. The claims office uses various networks to ensure best possible contracted price for the services rendered.

3. In the event, a claim is denied, you will receive Explanation of Benefits and reason for denial. You are welcome to contact the examiner to seek additional information or India Network Office to help you understand your benefits. Under no circumstances, an insured purchasing $50,000 policy can expect or receive benefits of $100,000 policy. SO BE CAREFUL IN CHOOSING THE LOWEST PREMIUM POLICIES.  UNDERSTAND THE BENEFITS CLEARLY BEFORE YOU CALL CLAIMS.

************more questions -- call our office 407-243-8760 *****