Non-medical items
Consumables and convenience items may be outside standard coverage unless an add-on includes them.
Health claim process
One difficult day. One clear next step at a time.
Cashless or reimbursement, planned admission or emergency - this is exactly what happens, what you need and what your MITRA claim expert handles.
Choose the route
Cashless and reimbursement solve the same claim differently
Cashless works at a network hospital and lets the insurer settle eligible costs directly. Reimbursement works at any eligible hospital, but you pay first and submit the complete file later.
| Cashless | Reimbursement | |
|---|---|---|
| Hospital | Insurer network | Any eligible hospital |
| Who pays first | Insurer for approved eligible costs | You |
| First document | Pre-authorisation request | Claim intimation and later full file |
| Best for | Planned or emergency network admission | Non-network care or cashless denial |
| Keep originals | For non-payables and follow-up | Essential for submission |
Follow this claim in the MITRA app. Once your expert files it, every step - pre-authorisation, the insurer's queries, settlement - updates live, and your expert is one tap away.
Your next step
Choose your claim process
Tell us what is happening right now. We'll show you the steps in the right order.
Planned route
Before a scheduled hospitalisation
- 01
Tell your claim expert
Share the hospital, doctor, diagnosis and planned date as early as possible.
- 02
Confirm the network
We verify the exact hospital branch and policy status before admission.
- 03
Send pre-authorisation
The hospital desk submits the clinical estimate; we check that it is complete and track it.
- 04
Admission and treatment
Carry the policy card and ID. Updates are sent if the treatment or estimate changes.
- 05
Final authorisation
The final bill is assessed; we reconcile approval, deductions and your non-payable share before discharge.
The complete file
Documents a reimbursement claim commonly needs
- Signed claim form and policy details
- Photo ID, KYC and verified bank proof
- Original itemised hospital bill and numbered payment receipts
- Discharge summary and final diagnosis
- Doctor's prescriptions, consultation papers and investigation reports
- Pharmacy bills matched to prescriptions
- Implant invoices and stickers where relevant
- FIR or medico-legal records for accidents
- Prior insurer settlement letter when a top-up is involved
Deductions explained
Why the approved amount may be lower than the hospital bill
Room eligibility
Choosing above the allowed room category can create a direct room deduction and, in some policies, proportionate deductions.
Co-pay or deductible
Your agreed share is applied before the insurer settles the balance.
Sub-limit
A defined cap for a disease, procedure or benefit can apply even when the overall sum insured is higher.
Not medically necessary
The insurer may question treatment, length of stay or investigations; clinical justification should be documented.
Waiting period or exclusion
Claims linked to an active waiting period or explicit exclusion may not be payable.
If cashless is denied
A denial at the desk is not always the final claim decision
Cashless can fail because the hospital is outside the network, documents are incomplete, the insurer needs more time, or the case requires deeper review. Ask for the reason in writing, preserve every original, pay only as needed for treatment, and prepare a reimbursement claim. MITRA reviews the policy basis and escalates unsupported decisions.
Questions
Health claim FAQs
Straight answers, in plain English.
How quickly should I intimate an emergency claim?
As soon as reasonably possible after stabilising the patient. Policies state their own window, so call your MITRA expert immediately and we will record and route the intimation.
Does cashless mean the entire bill is free?
No. The insurer pays eligible expenses under the policy. Co-pay, deductibles, non-medical items, amounts above sub-limits and excluded costs can remain with you.
What if the hospital is not in the network?
Use reimbursement: take treatment, pay the hospital, preserve the complete original file and submit it under the policy timelines.
Can I claim from two health policies?
Yes, subject to coordination-of-benefits rules. The first insurer settles and the second can consider the remaining eligible amount with the first settlement letter and certified records.
Is MITRA's advice really free?
Yes - consultations and claims support are free for you. Like all insurance intermediaries, we earn a standard commission from insurers when a policy is issued. Our advisors are measured on fit and claim outcomes, not sales targets.
What does claims support include?
A dedicated claim expert prepares and verifies your documents, coordinates with the hospital, insurer or TPA, resolves queries, and explains the final settlement in plain language. It is included for policies bought or ported through MITRA.
Can MITRA guarantee that my claim will be paid?
No intermediary can decide or guarantee a claim outcome. The insurer decides based on policy wording and the facts of the claim. MITRA makes sure your file is complete, follows up, contests unsupported deductions and escalates when valid grounds exist.
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