1. How Cashless hospitalization Works?
Health insurance companies tie up with different hospitals after checking quality of their medical services and negotiating rates for different procedures. These hospitals are known as network hospitals and when you get hospitalized in any one of them, you do not have to settle the bill with the hospital. Your insurance company that is represented by TPA (third party administrator) will coordinate and settle the bill with the hospital.
Athaayu Hospital offers state-of-the-art diagnostic, therapeutic and intensive care facilities in a one-stop medical center.
You know beforehand that you will be hospitalized in next few days and it means, you have ample time to decide from which we help you to avail our services.
Here is what you need to do-
- Read your health insurance policy and Contact us for insurance to know your insurance is tied up with our hospital.
- after Conformation take your policy card to the hospital and ask for a pre-authorization form, which you can get from the insurance desk at hospital or you can also download it from the Hospital website. Usually, the first part is filled by the patient, while the other part is filled by attending physician.
This is where you need immediate medical care. You should make sure that you initiate the cashless Mediclaim facility within 24 hours of hospitalization.
Things you will need to do are-
- Show your health insurance card at the hospital, which will contain your policy number, name of your insurance company and the type of health policy you are holding.
- Fill in the pre-authorization form after which the person at the insurance desk will expedite your claim process. However, if you can’t wait for the TPA approval, you can pay hospital bills and later reimburse it from your insurance company.
4.What is not paid in the cashless health insurance
There are some expenses which are not even covered by cashless hospitalization-
- Attendant/Visitor fees
- Ambulance charges
- Service charge
- Expenses for oxygen mask, diapers, nebulizers, etc.
- Documentation charges
5.Top Reasons For Claim Rejection in Mediclaim Policy
Wondering why your claim is rejected by the insurance company? We have listed below some of the top reasons of rejection-
- If the illness for which you have been hospitalized is not covered by your insurance policy
- If you exhausted entire sum assured for that period
- If the information contained in the pre-authorization form is insufficient to approve the claim
- If the information provided on the pre-existing ailment is insufficient in the pre-authorization form
- Delay in intimating TPA about hospitalization
6. What is not paid in the cashless health insurance
- Cashless hospitalization is available only at network hospitals
- It is the hospital responsibility to give a justification of the treatment you are undergoing
- Remember to keep a photocopy of all documents, including medical bills, lab reports, claim form and discharge papers
- Remember to carefully read terms of your cashless policies because there are many conditions that could make you ineligible to avail cashless hospitalization
- Usually, an insurance company agrees to pay part of the sum required for the treatment of the patient. In some cases, if the policyholder exceeds the sum assured, then the policyholder will require to pay the excess amount