THE RIGHT WAY FOR HEALTH INSURANCE
CASHLESS CLAIM DURING PLANNED HOSPITALISATION
Health costs are high, rising and expected to rise in the coming years. It is essential to cover yourself and your loved ones under the umbrella benefits of health insurance that helps to smoothen the claim process. The submission of claims for medical expenditure is process driven for the two kinds, namely Cashless Claim and Reimbursement Claim. Cashless claims are disbursed in two ways - one where the approval is taken 24 hours prior to hospitalisation and two, where the approval is taken within 24 hours of hospitalisation.
1 THE HOSPITAL'S
help desk will help the insured complete the formalities like filling up pre-authorisation form, getting signed by both you, the insured, and doctor. This is then forwarded to the insurance company along with the necessary documents 24 hours before hospitalisation.
2 THE INSURANCE
company will then review the cashless claim authorisation request. It will approve the cashless hospitalisation request and raise a query if required any clarification. It may seek additional documents as required, or reject the request.
3 IF THE
cashless hospitalisation is approved and if all charges are within the policy’s limit, the insurance firm will pay the bill directly to the hospital. Bills in excess of the limit will have to be borne by you. All original hospitalisation paperwork will be given to the insurance firm by the hospital directly.
4 IF THE
insurance company has raised a query and it has been satisfactorily resolved by the insured and hospital, the cashless hospitalisation request will be approved.
5 IF THE
cashless hospitalisation request is rejected outright or after the response to the insurer's query is unsatisfactory, then you will have to pay the hospital bill on your own, and collect all the original documents and receipts. Whether the insured can subsequently approach the insurance company to submit a claim for reimbursement of expenses will depend on the reason cited for rejection of the cashless claim. If the cause of the hospitalisation is not covered by the health insurance policy, then the insured cannot file for a claim.
6 IN THE
EVENT OF EMERGENCY HOSPITALISATION, THE STEPS ARE SIMILAR EXCEPT FOR THE FIRST ONE. THE PRE-AUTHORISATION FORM IS TO BE FILLED AFTER HOSPITALISATION, BUT WITHIN 24 HOURS OF HOSPITALISATION.