Pre- and post-hospitalisation expenses not paid — how do I claim them?

Pre- and post-hospitalisation cover pays medical expenses in a set window before admission and after discharge. In one insurer's wording, for example, they must be for the same condition, and the hospitalisation claim itself must be admissible. Your policy sets the windows and the submission deadlines. If these bills were refused, check the dates, the link to the admitted condition, and whether the main claim was accepted.

These are the bills that surround a hospital stay: the scans and consultations that led to admission, and the medicines and follow-up visits after it. They are claimed under the same policy, but on conditions of their own.

What the cover requires

The windows are set by each policy; the standard Customer Information Sheet leaves the number of days for the insurer to fill in. One insurer's product pays pre-hospitalisation expenses for 30 days before an admissible hospitalisation, and post-hospitalisation expenses for 60 days after discharge.^{[1, 2]}

The same wording adds two conditions: the expenses must be for the same condition that required the hospitalisation, and the in-patient claim for that hospitalisation must be admissible.^[2]

Why these bills are refused

• Outside the window: Count the days from the admission date backwards and from the discharge date forwards, using the dates on the hospital's papers.^[2]
• Not the same condition: A prescription or report that does not name the condition can look unrelated. Ask the doctor to note the diagnosis on prescriptions issued after discharge.^[2]
• The main claim was not admissible: Under a wording like this one, if the hospitalisation claim was rejected these bills fall with it, so challenge the main rejection first.^[2]
• Treated as out-patient expenses: One insurer's wording excludes OPD treatment, so a bill has to be tied to the admission to be paid as post-hospitalisation.^[2]
• Submitted late: Post-hospitalisation bills can have their own deadline; one insurer's product asks for them within 15 days of finishing that treatment.^[2]

How to claim them

1. 1

   Keep each bill with its prescription

   A bill for a scan or a medicine is far easier to link to the admission when it sits with the prescription that ordered it.

2. 2

   Send pre-hospitalisation bills with the main claim

   One insurer's deadline for reimbursement of hospitalisation, day care and pre-hospitalisation expenses runs from the date of discharge.^[2]

3. 3

   Send post-hospitalisation bills after the treatment ends

   Collect them through the window and submit them together, within your policy's deadline.^[2]

4. 4

   If refused, ask for the clause

   A partial disallowance must give details with reference to the specific policy terms. Ask which condition the insurer says was not met.^[3]

ClaimAssure is an independent private platform. It is not an insurer, IRDAI, Bima Bharosa or the Insurance Ombudsman, it never files anything on your behalf, and it cannot promise any outcome. What it does is read your documents and show you what they say.

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