Insurance

Two Health Insurance Policies, One Missing Letter: A Balance Claim Story

A maternity claim showed me that a cashless approval and a claim settlement letter are not the same thing. If you plan to claim the balance from a second health policy, the gap between the two matters.

9 October 2026 · Raja Banka · RHB Wealth Pro, Salt Lake, Kolkata

The call came after the baby was home. Mother and child were well, the hospital bill was cleared, and my client had one question: where was the letter?

Here is the background. His family policy, placed through us, covered maternity up to ₹50,000. His wife also had a group health policy through her employer, which could cover the amount above ₹50,000. The plan was straightforward. Use our policy cashless at the hospital, pay the rest at discharge, and claim that balance from the employer's insurer.

The first half went to plan. The cashless claim was approved and cleared within the stipulated time.

The catch

To pay the balance, the second insurer needed the first insurer's claim settlement letter, which shows the bill, the amount paid and the deductions. Without it, the second insurer cannot tell where its share begins.

We asked for the letter, and the insurer could not issue it. In a cashless claim, the approval at discharge is a commitment to pay the hospital. The claim is settled on paper only when the hospital submits its final claim file and the insurer actually pays it. Here, the hospital and the insurer had a mismatch over the claim, and their settlement took a long time. Until money moved between those two, there was no letter, and my client's balance claim waited on a transaction he had no part in.

What we did

The client kept in touch with me, and I kept following up with the insurer: where is the file, what is pending, who has to act next. Once the hospital was paid, the settlement letter was issued, and we made sure it reached the client so he could file with the second insurer.

We handle about 91 health claims a year. Queries and deductions are routine. A balance claim held up by a letter that could not exist yet was a first for me. It ended well, and it is worth knowing before you need it.

Claiming the balance from a second policy

1. Pick the order before admission. If one policy can cover the whole bill, using only that policy avoids a second claim.
2. Inform the second insurer early. Intimate the claim within its deadline and say a balance claim will follow.
3. Keep copies before originals go. Final bill with itemised break-up, discharge summary, reports and payment receipts. Ask the hospital to attest them.
4. Watch the letter and the deadline together. If the settlement letter is late, write to the second insurer before its submission deadline, explain why, and keep the email trail.

Questions this raises

Can I claim from two health insurance policies for one hospitalisation?

Yes, for indemnity policies that pay hospital bills. The standard multiple-policies condition in health policy wordings lets you claim amounts one policy did not pay, including amounts above a sub-limit such as a maternity cap, under another policy, subject to that policy's terms. Together, the two cannot pay more than the actual bill.

What is a claim settlement letter?

A statement from the first insurer or its TPA showing the amount claimed, the amount paid and the deductions. The second insurer uses it to pay only the gap.

Why is my settlement letter delayed after a cashless claim?

Usually because the insurer has not yet paid the hospital. Ask the insurer or TPA whether the hospital's final file has reached them and whether any query is open.