4 Essential Steps to File a Medical Insurance Claim

Medical Insurance Claims- Health Insurance- Gargash Insurance 07 Dec, 2022

Insurance claims can be a time consuming and tedious task. Taking the assistance of an insurance broker can help you save time in claims processing. Read on to know more about the essential steps of filing a medical insurance claim.

The final step to reap the benefits of buying medical insurance is to file a claim. Moreover, filing a claim in a medical crisis is the reason we buy insurance in the first place. Despite what is said, medical insurance claims are seldom easy to submit and settle. The claiming process involves multiple steps, and even the slightest negligence can delay or cause it to be rejected altogether. However, it is necessary to file the claim with appropriate documents for easy settlements when in need. An expert insurance broker will guide you through the claims process and settle your medical insurance promptly and efficiently on behalf of you with the insurance company. Our blog will provide simple and essential steps to claim your medical insurance.


Quick Read Section

  • Claim on the policy can be availed by the insured, as a direct billing facility with medical service by showing health insurance card or through reimbursements process post availing the treatment, by filling claims form.
  • The documents required for the claim must be in English or Arabic.
  • Discuss the terms and conditions of your medical insurance claim with your insurance provider.
  • Get to know the submission period for your claims, as most insurance providers offer a 30-60 days period from the date of treatment.
  • The ideal settlement period is 14-21 working days. However, discuss the timeline with your insurance provider.
  • Keep photocopies of all the medical documents you submit, including receipts, cash memos, and invoices.
  • Many insurance providers may require a medical report from the treating doctor of your ongoing treatment. Verify the documents needed and submit them in time.
  • You can also take assistance from an insurance broker to file a claim with the insurance companies. It will ensure minimum hassles in approval of claims.


Necessary Steps to Remember When Filing a Medical Insurance Claim through Cashless Mode or Reimbursement Mode

  • Keep the Documents Handy: Documents are essential to filing an insurance claim. Obtain a list of the required documents from your insurance provider. Provide every document listed because negligence in documentation can cause delay or rejection of your claim. Direct billing or cashless claim settlements don’t need many documents, but can be availed on presenting health insurance cards. On the other hand, reimbursement claims require all the receipts and invoices of the treatments you are claiming. Ensure you have both soft and hard copies of all the documents.
  • Maintain Your Receipts: While cashless direct claims don’t require receipts, every single receipt is important when filing a reimbursement claim. You will need credit and debit card slips, treatment receipts, medicine, test, services slips and cash memos. Treasure all your original memos and receipts and make a copy for later use. You may be required to submit the original documents, which are not returned if the claim is approved.
  • Check for Errors: Avoiding errors in the filing process is the first and most crucial step in the claiming process. Check for any administrative errors, missing documents, receipts and bills. All these minor errors can delay or get your claim rejected. You can file for a claim after rectifying any mistakes, but the resubmission process may delay your settlement process. Therefore, it is always helpful to double-check all the necessary documents and forms before submitting.
  • Keep an Eye on Deadlines: During a medical crisis, things may go haywire and cause confusion. However, starting your claiming process well in advance is vital to not missing any deadlines. Manage your claiming process within the timeline and save enough time to recheck it to avoid delays or rejections.


What are the Important Documents Required for Reimbursement of Health Insurance Claims?

In contrast to what you may have heard, claim reimbursement is simple and hassle-free. Although, you will require a set of documents and follow a thorough process to submit your claim for approval. Below are the documents you will need to complete the claim reimbursement process.

  • A duly filled, stamped and signed claim reimbursement form from your medical insurance provider.
  • Original copies of the medical bills and invoices that are subject to reimbursement, including pharmacy receipts, ambulance slips, and additional refunds you want to file.
  • Test reports from labs.
  • Policy details of the policyholder and hardcopy of the UAE insurance.
  • Bank details of the policyholder.
  • Letter of reference from your doctor.
  • Any other specified documents asked for by the insurer.


How Does the Health Insurance Claim Process Work?

When discussing about health insurance in the UAE, you might frequently come across the term “network hospitals.” The word network hospitals state a chain of hospitals and medical centres with which your insurance company has an association. These chains of hospitals have a crucial role in the claim settlement process. Fundamentally, there are two ways in which you can claim insurance in the UAE.

  • Claims Devised within the Hospital Network: According to this criteria, the claim made for the available treatments and services from the hospitals in association with your insurance company is a part of the so-called “network.” This feature allows the policyholder to avail of treatments, procedures, and services included in their healthcare plan without any costs, as long as they are within the specified sum assured of the policy. The network of hospitals allows the policyholder to avail of cashless claims.
  • Claim Excluding the Hospital Network:  The hospitals that are not in direct association with your insurance provider, are classified as “outside the hospital network.” In such cases, policyholders are subjected to pay for all treatments, procedures and consultations from the hospitals excluded from this network. However, the policyholder can raise a reimbursement claim for these services with the help of the claim reimbursement form. Nevertheless, these reimbursement claims depend on various terms and conditions and the policy’s eligibility criteria.


Insurance claims are a time consuming and tedious process. Taking the assistance of an insurance broker can help you save time in claims processing and also help you choose the best health insurance policy for you and your loved ones.


*By submitting this form, you consent to be contacted by Gargash Insurance over phone/e-mail/SMS/WhatsApp for insurance related communications.