Today, most Health Insurance policies do offer cashless hospitalization facility. They manage the cashless procedure in-house or route it through a Third party Administrator (TPA). First, you need to be clear that there is no free treatment. It is just that, in the case of a cashless hospitalization, the insurance company will bear the cost of treatment either fully or partially on your behalf. It is important to understand the role of a Hospital in cashless hospitalization. The Hospital is only a facilitator and has no authority to approve or disapprove any request for cashless hospitalization.
Hospitalization can be either Planned or Emergency. Pre-authorization approval of the estimated hospital expense is a must to avail this facility. In the case of a Planned Admission, you would first consult our doctor who in turn would advise you the probable date of hospitalization. In such a case, you must apply for an approval of the estimated hospital expenses directly with your TPA at least 4-5 days prior to the date of hospitalization.
In case you have not applied for a pre-authorization sufficiently in advance or if the doctor treating you advises you to get hospitalized immediately after the consultation, our Cashless Medical Insurance Help Desk will assist you through the pre-authorization procedure. However, you will need to bear in mind that the Hospitals Cashless Medical Insurance Help Desk is only a facilitator and can in no way influence the decision on the approval.
At Insurance Cell, you need to present the original health Insurance card issued to you by your TPA, produce a photocopy of ID proof issued by Govt. Authorities (PAN card/ Driving Licence/Voter ID card etc) and photocopy of employee ID card if it is a corporate group insurance policy.
Cashless hospitalization is linked to the approval of the estimated expenditure of your proposed treatment. In case you do not get your approval you will need to bear the entire expenditure incurred on the treatment. Therefore it is always prudent to get the approval and then get yourself admitted.
In case your hospitalization expenses exceed the pre-approved amount, you can approach the Cashless Medical Insurance Help Desk to apply for an enhancement of the pre-approved amount.
The Insurance Cell will apply for an enhancement on your behalf with the TPA and provide the necessary documentation. If the TPA turns down the request for enhancement you will need to pay the amount incurred in excess of your approved amount directly to the hospital before the discharge.
For complete details on the medical expenses that are covered, and those that are not covered, you need to go through your health insurance policy / IRDA. However, in general, the expenses listed below are not covered under cashless hospitalization.
These along with the non payable amount as per your final cashless approval need to be settled by you directly to the hospital at the time of discharge when the final approval is received after sending the final bill and the discharge summary.
This list is subject to change and the same should be confirmed from our Cashless Medical Insurance Help Desk at the time of admission of the Patient.