Health Insurance Plans

pays for your hospital bills for diagnostics, surgery etc.

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Cashless Hospitalization

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You must have received a call at least once in your life from a friend or a relative telling you about an emergency Hospitalization and the urgent requirement of cash. You need to hurry to the nearest ATM, sometimes even at odd times and withdraw thousands of rupees needed for paying the expensive bills of good quality hospitals today. Cashless Hospitalization is a Health Insurance developed to avoid such panic and tensed situations.

With cashless health plans, you do not need to settle the bill with the hospital as long as the hospital is in the network of the insurance company you are associated with. A representative from your health insurance company gets in touch with the hospital to settle the bill.

Third Party Administrator

Some of the best health plans offered by companies have tie-ups with hospitals. They negotiate for rates and check the quality. These hospitals are said to be Network Hospitals. Cashless Hospitalization can be availed only in these specific hospitals. If you want to know which hospitals are in the network of your health insurance, read the name of your TPA on the Policy and contact them.

Third Party Administrator is the representative of the health insurance company offering you cashless hospitalization. They perform the job of settling bills for you at the hospital. They make claims for both Reimbursement and cashless hospitalization services. You need to get your cashless hospitalization request approved by them to avail the service.

Process for availing Cashless Hospitalization service on health insurance in India:

In case of planned hospitalization

If you have been recommended by your doctor to get admitted, you have time to choose a hospital. Health insurance in India mandates that you complete all formalities 3-4 days prior to hospitalization:

  • Check out the list of hospitals mentioned in your health plan and choose the network hospital that is closest to your home.
  • Provide your insurance card at the insurance desk of the hospital and fill in all the information required in the first part of the pre-authorization form. This has to be filled by the patient itself.
  • The rest of the form shall be filled by the physician attending to you.
  • Submit the filled form at the insurance desk. The person on duty shall check for the completeness of the form and then send it to the TPA via fax.
  • The form will be rejected or accepted by the representative after processing it.
  • Once the administrator approves your form, he or she will send an authorization letter back to the hospital with the approved amount for the treatment mentioned.
  • It is your responsibility to follow up with the representative to know about the progress of your cashless hospitalization request.

In case of Emergency hospitalization

When a patient is admitted in emergency, treatment comes first and then health insurance. The best health plan is one which initiates the process for cashless hospitalization within 24 hours of admission to the hospital. Following procedure need to be followed in case of emergency hospitalization:

  • Show your health card and provide details in the pre-authorization form.
  • Persons at the insurance desk will cooperate with you and fast track the process. If you think that waiting for the approval can be risky, pay the deposit money asked for by the hospital and let treatment begin. The expenses can be reimbursed later as part of your best health plan.
  • Usually an emergency approval is given in 6 hours if all details are accepted. Remain in constant touch with the insurance provider to know the status.

Cashless hospitalization is an important feature to consider while choosing the best health plan. Health insurance in India offers a variety of health plans with different Network Hospitals and cashless hospitalization benefits added to them. So choose one based on your convenience and requirements.