Saif Ali Khan attack: How to claim from your health insurance policy for emergencies and planned treatments

Saif Ali Khan’s sudden hospitalisation has once again underscored the unpredictability in life. Medical emergencies can strike anytime, making health insurance crucial. Knowing the claims process in advance can help avoid last-minute stress.

The Bollywood actor was critically injured in a violent knife attack during a break-in at his residence. Currently recovering at Mumbai’s Lilavati Hospital, Saif Ali Khan has a health insurance policy with Niva Bupa. He filed a claim for Rs 35.95 lakh, of which Rs 25 lakh has already been approved for cashless treatment.

Niva Bupa confirmed the approval, stating that the remaining amount will be settled once the final bills are submitted, as per policy terms. "We are deeply concerned about the unfortunate incident involving Mr. Khan and wish him a speedy recovery. As one of our policyholders, his hospitalisation triggered a cashless pre-authorisation request, which we approved to initiate treatment. The final settlement will be processed upon receipt of the complete medical bills," the insurer said in a statement.

This incident highlights the importance of understanding how health insurance claims work. Whether it’s a planned procedure or an unexpected hospitalisation, knowing the process in advance can help expedite claim approvals.

Health insurance claim process for emergency hospitalisation

In medical emergencies, quick action is crucial. Here’s how to navigate the health insurance claim process efficiently in case of emergency hospitalsation

Step 1: In emergency cases, an advance deposit may be required at the time of admission.  Keep KYC documents ready for verification.  
Step 2:  Inform the insurance company or Third-Party Administrator (TPA) as soon as possible through their helpline.  
Step 3: Provide the hospital with the patient’s health insurance card and a valid photo ID.  With the hospital’s assistance, send a pre-authorisation request to the insurer/TPA.  
Step 4: The hospital forwards the request along with medical details such as investigation reports.  
Step 5: Pay any non-reimbursable expenses.  Collect copies of all reports and the discharge summary for personal records, as the originals remain with the hospital for claim processing.  
What if pre-authorisation is rejected? If the insurer denies cashless treatment, you can still claim reimbursement by submitting original bills and documents to the TPA after discharge.

Health insurance claim process for planned hospitalisation

Step 1: Select a network hospital covered by your insurer. Finalise the treatment plan, admission date, and estimated expenses.
Step 2:  Inform your insurance provider or TPA at least 48–72 hours before admission. Submit a pre-authorisation request through the hospital’s accounts department, which will forward it to the insurer or TPA.
Step 3: Present the pre-authorisation letter and a valid photo ID at the time of admission. Some hospitals may require an advance deposit, which is refunded after discharge or upon claim approval.Submit KYC (Know Your Customer) documents as required.
Step 4:  Pay for non-reimbursable expenses as per the policy terms. Collect copies of medical reports and the discharge summary for your records, as the originals remain with the hospital for claim processing.

Claim process for reimbursement (If hospital is not in network)

If you undergo treatment at a non-network hospital, follow these steps to claim reimbursement:
Step 1: Notify the insurer’s call center within 15–30 days of discharge as time limit may differ from insurer to insurer.
Step 2: Receive claim number. This reference number should be used for all future communication.
Step 3: Send the completed claim form along with all original bills and medical documents to the TPA. If additional documents are needed, the insurer will request them within seven days of receiving your claim. Once all documents are verified, the insurer will process the payment within 30 days.