Important Things to Know about Cashless Hospitalization

Have you ever needed to rush to an ATM in the middle of the night because someone had to be hospitalized due to an emergency? Have you called your friends or relatives seeking cash for hospitalization?

Cashless hospitalization aims to avoid such instances in case of an emergency. The insurance company directly settles all the bills with the hospital. However, this amount is limited to a maximum of the sum assured under your health insurance policy.

Cashless hospitalization procedure

The insurance companies tie-up with different facilities after analyzing their medical services. These facilities are included in the cashless network and when you avail of treatment in these, you do not have to pay any money to the hospital. The insurance company uses third-party administrators (TPA) to coordinate with the hospital and directly settle the dues.

The cashless hospitalization process may be done in the following two ways:

  1. Planned hospitalization

In this method if you are unable to plan and determine about the list of network hospitals, then check your policy document or call the toll-free number to know the network hospitals. Here are the steps you must follow.

  • Procure pre-authorization form from the insurance desk at the hospital or download through the TPA website. The form must be duly filled by the patient and the physician.
  • The completed form must be submitted to the insurance desk where it is thoroughly reviewed for authenticity.
  • The form is then submitted to the TPA and the TPA then approves the same.
  • After that, an authorization is sent giving the sanctioned amount details.
  1. Emergency hospitalization

In case you need to be admitted in an emergency, you need to follow the below mentioned steps:

  • Show your health insurance card that includes the policy number and details of the type of coverage you have.
  • Duly fill the authorization form available at the insurance desk to expedite the process.
  • In case you are unable to wait for the approval from the TPA, you may settle the hospital bill and later file a reimbursement claim.

Let us now see how cashless hospitalization works.

  • It is very important to remember that this facility is available only at the network hospitals. The list is available on the insurer’s website and you may search for cashless hospitals in Mumbai, Pune, Hyderabad, Agra, Kolkata, or your city.
  • Planned claims require informing the insurer in advance. The company will pay the pre- and post-hospitalization expenses.
  • Emergency hospitalization must be intimated to the insurance company within the maximum stipulated period. This information will be available in the policy document.

Benefits of cashless hospitalization

  • You do not have to worry about finances in case of a hospitalization, thus giving you peace of mind.
  • You are assured of receiving the best medical treatment when you know you are adequately covered.

When you avail of cashless hospitalization insurance, it is important to read all the terms and conditions and understand the inclusions and exclusions to avoid any surprises. It is also important you retain copies of all bills, reports, claim forms, and discharge papers as these may be required in the future.

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