pays for your hospital bills for diagnostics, surgery etc.
When you are suffering through health troubles, there are various things to deal with, but getting the cashless Claim for the health Policy you’ve chosen is really important. Generally, people seeking for cashless treatments and Hospitalization are suggested to have an agreed sum Assured plan in health cover policies, which come with defined benefits to the Insured party. The insurance companies have their networked hospitals, in which you can get the cashless treatment for the ailments listed in terms and conditions of Health Insurance policies. These facilities are made available for emergency cases as well as general hospitalization.There are certain steps you need to follow in order to enjoy the benefits of cashless treatment in advanced health facility offering hospitals.
TPA (third party administrator) is the first department to be coordinated and informed about the emergency hospitalization requirement that the insured patient has. The TPA desk can be contacted via the toll free numbers at any hour of the day. In emergency hospitalization, the TPA department should be contacted within 24 hours and for planned hospitalization, TPA should be intimated three days prior to the admission.
The form filled for getting cashless settlement during the treatment should be certified by the doctor. After filling this request by hospital department, it is sent to the TPA through fax for further course of action.
The individual filing claim for cashless medical benefits of the mediclaim insurance policy should not forget to attach all the required documents to proceed further in this procedure. Along with that don’t forget to submit your health ID card to the insurance desk of hospital. These documents are required for the detailed scrutinization by the TPA desk.
All these documents are taken under careful consideration and scrutinized by the experts. After this, they decide whether to pass the claim or reject. Whatever the decision is, the third party administration informs the insurance holder within six hours of filing the claim via SMS or Fax.
Imagine a situation when you contact your insurance company to register the claim and your Mediclaim gets denied. Here are few things you must keep in mind to avoid claim rejections. In many cases denials are outcome of actions that are well within your control.
In majority of cases health insurance claims are rejected because of missing data. You can avoid such situations by ensuring that your per-authorization requests include accurate information about the patient. Appropriate documentation can also help in such a situation.
Besides this, it is also important to know the health plan's coverages and exclusions. Many denials occur due to ignorance. Make sure to read each and every detail mentioned in the policy contract. Make sure the treatment you are taking in the hospital is covered under your insurance policy before you actually receive the treatment.