The cost of Hospitalization has magnified over the last few years.
It is not within the financial scope of most Insured to pay for the cost
of hospitalization from their savings and in such cases cashless
hospitalization becomes important.
Here, we discuss some important facts regarding cashless hospitalization, which you must be aware of.
Cashless Claim is available only in the network of hospitals pre-approved by the insurance provider
most important pre-requisite for you to get cashless claim is that you
should take your treatment in a hospital that is pre-approved by the
insurance service provider in their network. The hospitalization may be
planned or you may take it for an emergency situation like an Accident
or a stroke.
a cashless claim, if it is a planned hospitalization, you would have to
inform the hospital in advance about your insurance plan. You can give
advance intimation of 3-4 daysto the hospital for the formalities. The
hospital would fill a pre-authorization form, which will carry details
of your Policy and the approximate cost of treating your illness, which
will be submitted to the Third Party Administrator (TPA) for
authorization. The TPA will check the policy terms and accordingly grant
the permission or reject the form. The TPA will inform about its
decision to the hospital via a fax.
lot of hospitalizations arise out of emergency and in such a scenario
you can demand a cashless claim, which has to be submitted to the
hospital within 24 hours of admission. No doubt it is a panicky
situation, but one of the relatives can come forward to managing the
formalities for a cashless claim. The Health Insurance card can be
submitted to the hospital and they will take care of the approval
process. The hospital will fast track the TPA approval process. In an
emergency situation, the TPA is required to process the claim within 6
hours of receiving the pre-authorization form. If it is not advisable to
wait, you always have the option of taking the treatment and then
filing for Reimbursement of the expenses incurred.
What if the TPA rejects your claim?
A TPA generally rejects the claim in following situations:
You have already exhausted your sum Assured limits
The illness for which you may be seeking treatment is not covered under the policy terms
you think the TPA has wrongly rejected your claim, you can still
proceed with filing a claim for reimbursement of your expenses. In order
to avoid such a situation, it is advisable to read the policy carefully
when you receive it. All health insurance
policy document explicitly state health conditions which are not covered by the policy.