Cashless Hospitalization Procedure
Health insurance companies tie-up with different Hospitals which are then called their ‘Network Hospitals’. The medical bills are directly settled by the Insurance Company, provided the total bill amount falls within the Assured Limit and the hospital is a Network Hospital. Following two ways :-
Planned :
Procure and Submit duly filled pre authorization form to the TPA (Third Party Administrator) of the Insurance Company.
Carry Policy/Health Card.
After Verification by TPA, approval mail/letter will be sent to the Network Hospital.
The Request will be processed and the Network Hospital will settle the Bills directly.
Emergency
Many a times, during certain emergency situations where immediate care is required, a person dosen't have time for certain pre defined formalities.
Your relatives may need to fill out the pre-authorization form at the hospital.
Carry the Health Insurance Card
Usually in such cases, forms are fast tracked and the claim request is processed by the TPA within few hours.
If there is delay in approval, one must settle the bill and later claim reimbursement amount.
Reimbursement Procedure - Non - Network Hospitals
Inform the Insurer within 24-48 hours.
During treatment collect all Bills, Reports, Test Results etc.
After Discharge collect documents like Pharmacy Bills, Prescription, Discharge Papers, Final Report etc.
Collect Original Copies of all the documents.
Submit the reimbursement claim along with all the documents for approval to Insurer Company.
After the Verification process, the amount is refunded within few days.
Documents Required
KYC, Identity Proof and Health Card
Medical Bills, Hospital Bills, Test Reports, Prescription etc.
Covid 19 Test and Treatment Related documents and tests
Discharge Documents from the Hospital
Any Other document demanded by Company
Cancelled Cheque, NEFT details (in some cases)
Other Points to Remember
Try and Intimate the Insurer at the earliest
Submit both Pre and Post Hospitalization Bills.
Know about the Policy completely
Read your policy regarding Home Treatment, Consumable Expenses etc.
Have to pay for any treatment that are excluded under Health Plan
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