scorecardresearchWorld Health Day: 5 steps to ensure a smooth cashless health insurance

World Health Day: 5 steps to ensure a smooth cashless health insurance claim

Updated: 07 Apr 2023, 11:36 AM IST

Claiming cashless health insurance may not be easy considering the hurdles that most policyholders are unable to foresee.

Health Insurance for you and your family.

Health Insurance for you and your family.

Many policyholders opt for cashless health insurance to relieve themselves of the need to pay cash to hospitals during treatment. However, a lack of knowledge of certain facts and factors has resulted in many people facing difficulties while making claims on their health insurance plans.

On this World Health Day, let us learn how taking care of certain necessary steps can smoothen the claim process.

Seek treatment at a network hospital

You must check the list of network hospitals in your health insurance policy document before deciding to buy the policy. This will help you to get the cashless facility at a network hospital where such a facility may already be available. You can also check for the list of hospitals from the insurance company’s website or its claim department. Check the list and choose your preferred hospital for cashless hospitalization and subsequent treatment.

Inform the insurer or its TPA

Make sure to keep the insurance company of your claim so that the insurer may register the same before approving the same. You may also intimate the Third-Party Administrator (TPA) in writing of your intent to claim the insurance amount. You will need to fill out and submit the pre-authorization form irrespective of planned or sudden hospitalization. The form can be either downloaded from the insurer’s site or procured at the hospital’s billing desk.

In the event of a pre-planned hospitalization, follow your insurance company’s guidelines regarding the intimation or pre-approval of hospitalization and the cashless cover amount. If you or your loved ones had to be hospitalized suddenly, the insurer must be informed within a day of being hospitalized. The insurer approves the cashless claim based on the details submitted in the form.

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Do not ignore the room rent limit

Some health insurance plans put a cap on the hospital room rent. Check for the room rent limit also called “room rent capping” in insurance terminology. If your policy contains room rent capping conditions, then opt for a room whose rent is within the allowed limit. If the actual room rent during hospitalization is higher than the allowed limit, the insurance company will not pay the claim amount in full and will deduct the amount on a pro-rata basis, thus, forcing you to pay for the remaining amount from your pocket.

Understand policy exclusions and co-payments

Many policyholders check for the ailments and expenses that would be covered under the insurance policy. This way they ignore the key exclusions wherein the claim amount would not be payable by the insurance company. The insurer would reject the claim if you seek payment for any excluded coverage, thus, impeding the cashless settlement process.

Health insurance plans bought for senior citizens often have co-payment options, which means that the insured may have to bear a part of the medical expenses. To avoid hassles, check for the co-payment clause and pay your share at the time of discharge from the hospital and complete settlement of the bill.

Keep your policy documents handy with you

Do not underestimate the need for complete documentation. At the time of bill payment, you may be asked to show your identity papers and policy documents. The hospital will ask for your papers to authenticate your identity before treatment and subsequent billing during discharge. Without policy documents, you will not be able to make the necessary claim.

Post hospitalization, submit your papers to the TPA who would look after the necessary documentation. You must then follow up with them so that there are no pending documents, reports or clarifications which may disrupt the claim process, thus, delaying the bill discharge process.

Cashless health insurance policies are most sought after owing to the ease of the settlement process. However, a few hiccups here and there can derail the entire bill payment process, thereby, depriving you of the necessary financial assistance when you need it the most.

First Published: 07 Apr 2022, 01:05 PM IST