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5 steps for a smooth cashless health insurance claim experience

Both planned and emergency hospitalizations can be serviced via cashless settlement

September 22, 2021 / 09:20 AM IST
Most health insurance companies offer cashless claim settlement of hospitalization bills. Though not complicated, it important to follow a set of steps and processes for you to make the claim settlement smooth. We want the settlement without any hassles or having to fork out our own money. Here are five key steps for an easy settlement.
Most health insurance companies offer cashless claim settlement of hospitalization bills. Though not complicated, it important to follow a set of steps and processes for you to make the claim settlement smooth. We want the settlement without any hassles or having to fork out our own money. Here are five key steps for an easy settlement.
Decide on a network hospital: Every insurer has tie-ups with hospitals all over the country. You should check your policy and and the insurer's website to locate a network hospital empaneled with your insurer for cashless service. The insurer would directly settle the bill with the hospital. Choose a hospital that is preferably near your residence, especially for planned hospitalization. Cashless settlement would mean you would have to pay nothing or at best a small amount from your own pocket.
Decide on a network hospital: Every insurer has tie-ups with hospitals all over the country. You should check your policy and and the insurer's website to locate a network hospital empaneled with your insurer for cashless service. The insurer would directly settle the bill with the hospital. Choose a hospital that is preferably near your residence, especially for planned hospitalization. Cashless settlement would mean you would have to pay nothing or at best a small amount from your own pocket.
Inform the insurer or TPA: In case of a planned hospitalization, you must inform the insurance company or the third party administrator (TPA) about your treatment. Do this a week before you plan to get admitted. Send the relevant medical documents and doctor recommendations to the TPA via email. Get a consent letter for cashless settlement. You must submit this letter at the hospital during your admission. In case of an emergency admission, you must inform the insurer or TPA within 24 hours of getting the patient admitted.
Inform the insurer or TPA: In case of a planned hospitalization, you must inform the insurance company or the third party administrator (TPA) about your treatment. Do this a week before you plan to get admitted. Send the relevant medical documents and doctor recommendations to the TPA via email. Get a consent letter for cashless settlement. You must submit this letter at the hospital during your admission. In case of an emergency admission, you must inform the insurer or TPA within 24 hours of getting the patient admitted.
Be aware of room rent capping: Many health insurance polices come with limits on room rents. Capping could be an absolute figure, say Rs 5,000 per day, or a percentage of sum assured, usually 1 percent. So, if you get admitted in a hospital that charges a higher amount , you may have to pay the remaining sum from your pocket. But If you buy a policy without any rent ceiling, you have nothing to worry.
Be aware of room rent capping: Many health insurance polices come with limits on room rents. Capping could be an absolute figure, say Rs 5,000 per day, or a percentage of sum assured, usually 1 percent. So, if you get admitted in a hospital that charges a higher amount , you may have to pay the remaining sum from your pocket. But If you buy a policy without any rent ceiling, you have nothing to worry.
Understand exclusions and co-pay clauses: The insurance company may not pay for use of disposables during the treatment and also not cover any registration or service charges. These are apart from not paying for a host of medical and pre-existing conditions. Then, there is the co-pay clause, wherein you need to pay a portion of the bill according to the insurance policy. Be aware of the amounts and stay prepared.
Understand exclusions and co-pay clauses: The insurance company may not pay for use of disposables during the treatment and also not cover any registration or service charges. These are apart from not paying for a host of medical and pre-existing conditions. Then, there is the co-pay clause, wherein you need to pay a portion of the bill according to the insurance policy. Be aware of the amounts and stay prepared.
Carry all the relevant identity and policy proofs: You must carry the insurance card that your company would have issued, and may be even the policy document. Also carry your PAN and Aadhaar cards, as also any other address proof. These, along with the medical documents and diagnostic reports would be needed during admission. You must make a habit of carrying your insurance medical card with you whenever you travel around. In case of an emergency, it can help in getting you admitted quickly.
Carry all the relevant identity and policy proofs: You must carry the insurance card that your company would have issued, and may be even the policy document. Also carry your PAN and Aadhaar cards, as also any other address proof. These, along with the medical documents and diagnostic reports would be needed during admission. You must make a habit of carrying your insurance medical card with you whenever you travel around. In case of an emergency, it can help in getting you admitted quickly.
Venkatasubramanian K
first published: Sep 22, 2021 09:20 am

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