pays for your hospital bills for diagnostics, surgery etc.
Over the last few years healthcare costs have grown disproportionately high. The treatment costs are so high that sometimes patients are not able to afford to pay out of their pocket and wait to get it reimbursed later from the insurance company. To deal with this situation, insurance companies have introduced cashless hospitalization.
Under Cashless Hospitalization if a patient is treated in any of the network hospital the patient need not make any direct payments for his treatment. The hospital expenses will be paid by the insurance company directly and the third party administrator will mediate between the hospital and the insurance company.
Thus, the patient can avoid the tensions of running for reimbursements and moreover he does not have to worry whether or not he has enough savings to pay the hospital bills. As in the case of cashless health plan, the insurance company would take care of the Hospitalization expenses on behalf of the patient.
There is a process mandated by the insurance company for you to avail cashless hospitalization. The procedure would depend on whether you are going for planned hospitalization or emergency hospitalization.
1) Four to five days before you need to take the treatment you have to visit the network hospital and ask for a pre-authorization form at the insurance help desk. Do not forget to carry your cashless hospitalization card that comes along with the Policy documents.
2) Fill up the pre-authorization form and make sure all the required details are correct.
3) Submit the form to the insurance desk and they will check for the completeness and correctness before they send it to the third party administration (TPA) of your insurance company.
4) The TPA will review your pre-authorization request for cashless hospitalization and they will review your policy terms to decide if they should accept or reject your request.
5) You can follow up with the TPA to know the status of your claim.
In case of emergency hospitalization the procedure essentially remains the same except that you can file a preauthorization request within 24 hours of hospitalization. The request will be processed by the TPA within 6 hours as soon as they receive the request.
When can a TPA reject your request for cashless hospitalization?Your pre-authorization request may be rejected under the following situations:
1) The treatment for which you are seeking hospitalization is not covered under your health insurance plan.
2) You have already exhausted the sum Assured limit due to a previous treatment that you would have undertaken during the course of the policy term.
3) The form has not been filled up correctly.
4) You have not paid your insurance Premium timely and your policy has lapsed.