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All insurers provide the option of cashless hospitalization to the customers. While selecting a policy, it should be an important consideration as it may get difficult for the customer to assess the available options during an unforeseen medical emergency.
Dhanush, 31 years old engineer with a multinational company, had bought a health insurance policy in 2008. He was happy paying the premium for the confidence it brought him, knowing that the medical need of his family would be fulfilled without any hassle. A month back, Dhanush got admitted into a private hospital for hernia surgery confident that it would be approved for cashless claim as this was the first time he was using his health insurance policy. To his surprise, it got declined by the TPA. He was shocked and called his insurer for clarity. Dhanush was then informed that the cashless claim is applicable only for network hospitals.
All insurers provide the option of cashless hospitalization to the customers. While selecting a policy, it should be an important consideration as it may get difficult for the customer to assess the available options during an unforeseen medical emergency. Had Dhanush read his policy terms and conditions carefully or opted for an insurer with personalized customer service to explain the step by step procedure to avail cashless claims, it would have been helpful in this situation.
It is crucial to file the claims appropriately as per the policy documents. It is therefore beneficial for the customers to understand what makes for the cashless hospitalization, how to go about it and what is covered and not covered under the policy for cashless claims.
3 steps to cashless claim:
Step 1: Select and approach the customer service of the insurer or the TPA helpdesk stationed at the network hospital. It is recommended to submit the request at least 72 hours before the treatment. In case of a planned hospitalization, it needs to be pre-authorised by the insurer. For identification purposes, use Passport, Voters' Card, PAN Card or Driver's Licence along with your health card provided by the insurer or the policy number. Max Bupa customers can check the list of network hospitals from the company website, Facebook page or by simply calling on the customer service number.
Step 2: Network hospital would check the identity for validation and submit pre-authorization form to the insurer. Max Bupa provides decision to the hospital within 4 hours, when no further document is required. In case of planned hospitalization it is advisable to file for the request as soon as the doctor advises hospitalization.
Step 3: Get admitted for treatment and sign all documents, forms and invoices on discharge
Key imperatives to be kept in mind:
Generally, an insurer will accept to pay only part of the sum required for the treatment of the patient, and settles the final bill with the hospital after the patient has been treated. In some cases if the policy holder exceeds the policy sum assured limit, then the policy holder will be required to pay the excess amount.
(The writer is CEO, Max Bupa Health Insurance)
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