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9 important things to know about cashless hospitalisation

Insurance companies use third party administrators to settles cashless claims availed by the policyholders during planned or emergency hospitalisation

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What is worst than an emergency hospitalisation at an odd hour? Probably the need to arrange emergency cash for treatment and hospitalisation.
Cashless hospitalisation comes to your rescue in such situations. Your health insurer directly settles all the bills with the hospital.
But the cashless payment is limited/equal to the sum assured as per your health insurance cover. It will lessen the immediate stress of paying cash for admitting the patient or start a treatment.
The most important fact about cashless hospitalisation is its availability at only network hospitals. The list of hospitals that offer cashless services vis-a-vis your insurance claim is mentioned on the insurer’s website.
Insurers have tie-ups with several hospitals for providing cashless medical services. Such hospitals offer cashless treatment the clients of the linked insurance company.
Insurance companies use third party administrators (TPA) to settles cashless claims availed by the policyholders during planned or emergency hospitalisation at network facilities.
For planned hospitalisation, get a pre-authorisation form from the insurance desk at the hospital/download it via TPA website. It should be filled by both the patient and concerned doctor.
The form should be submitted to the TPA desk of the hospital. It will authenticate the claim and send for authorisation with sanctioned amount details to the insurer.
For emergency hospitalisation, one must produce their health insurance card/TPA card at the hospital. This card will have the policy number and details of the type of coverage.
You can follow the same procedure of filling the authorisation form and sending it to the TPA for review and approval. If there’s no time to wait for TPA approval, pay the bill and get the amount reimbursed later.
While planned claims require informing the insurer in advance, emergency hospitalisation must also be intimated within the maximum stipulated period mentioned in the policy document.
Even for cashless treatment, ensure retaining copies of bills, reports, claim forms and discharge papers. These can be required in the future too.
Published: August 25, 2021, 14:25 IST

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