Recent updates in health insurance rules have increased the reach of cashless treatment. Now policyholders are allowed to get treatment even in out-of-network hospitals without paying advance payment. Let us understand how health insurance holders can avail cashless treatment in any hospital…
- Understand your policy: First of all, find out whether your health insurance policy has been updated with the new changes or not. Some policies may require upgrades or adjustments to facilitate cashless treatment in non-network hospitals. Also get information about the things not included in the policy and its limits.
- Pre-Approval Process: You can now get cashless treatment in non-network hospitals, but it requires pre-authorization. This is an important step to avoid out-of-pocket expenses. Before or shortly after hospitalization, you or the hospital must notify the insurance company, who will review the treatment plan and estimated costs.
- Steps of Pre-Authorization: Send the health insurance card, valid identity card, medical report and estimated cost of hospital treatment to the insurance company. Wait for approval. Insurance companies usually respond within 1 hour.
- Keep documents ready: Have the following documents ready for the pre-authorization process and your claim to proceed smoothly: Health Insurance Card or policy details, valid identity proof (Aadhar Card, PAN Card, etc.), medical report including doctor's prescription and all tests Results should be included. Apart from these, there should also be a treatment assessment of the hospital.
- Emergency Cases: In case of emergency, some insurance companies provide authorization after treatment. This provides the facility to get immediate treatment and get approval later. To avail this benefit, the insurance company will have to be informed within 24 hours of hospitalization.
- Get help from the hospital's TPA desk: Most hospitals have a third-party administrator desk or TPA desk. The TPA desk acts as an intermediary between you, the hospital, and the insurance company. TPA Desk provides free service for getting treatment and processing claims based on your health policy. Here you will get guidance on what expenses will be covered in the claim and how much you will have to pay out of pocket.
…
Graphics Source: VaskarAssets
