Recent reforms in health insurance regulations have increased access to cashless treatment. Now policyholders are allowed to seek treatment in out-of-network hospitals without making any advance payment. Let's understand how health insurance holders can get cashless treatment at any hospital…
- Understand your policy: First of all, find out whether your health insurance policy has been updated with the new changes. Some policies may require upgrade or adjustment to facilitate cashless treatment in non-network hospitals. Also get information about the things not covered in the policy and its limits.
- Pre-Approval Process: Now you can get cashless treatment in non-network hospitals, but it will require pre-authorization. This is an important step. Before or shortly after hospitalization, you or the hospital should notify the insurance company, which will review the treatment plan and estimated costs.
- Pre-Authorization Steps: Send health insurance card, valid identity card, medical report and estimated cost of hospital treatment. Wait for approval. Insurance companies usually respond within 1 hour.
- Have documents ready: For the pre-authorization process and to proceed smoothly with your claim, keep these documents ready: Health insurance card or policy details, valid identity proof (Aadhaar card, PAN card, etc.), medical report, doctor's note including prescription and all test reports included. Must be. In addition, there should be an assessment of hospital treatment.
- Emergency cases: Some insurance companies provide post-treatment authorization in case of emergency. This facilitates immediate treatment and approval later. To get this benefit, the insurance company has 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. The TPA desk offers free-of-charge services for seeking treatment and processing claims based on your health policy. Here you will find guidance on what expenses will be covered in the claim and how much you will have to pay out of pocket.
Image Credit: (Divya-Bhaskar): Images/graphics belong to (Divya-Bhaskar).
