All of the top health insurance companies have started handing out cashless health insurance policies to individuals. This is because these policies have become absolute necessities to cover the already high, yet still increasing prices of hospitalization. They help in relieving the stress on you when trying to arrange the huge sums required to foot the bills of emergency or even planned hospitalization. So it is of utmost importance to properly understand the inner workings of cashless hospitals and hospitalization.
The Inner Workings
- Forging Ties with Hospitals – Arguably, the most important thing that you have to keep in mind is that cashless benefits are only on offer in the hospitals that fall under the network of your insurance provider. The insurers forge ties with different hospitals across a designated area on the basis of top quality medical service provided by them. The insurers check their services and the rates that these hospitals charge for the procedures during treating a patient.
- Reaching an Agreement – Once their check is complete the insurers come to an agreement with these hospitals and thus form entire networks of these “cashless hospitals” so that policyholders like you can enjoy financial benefits during hospitalization.
- Availing Benefits – Policyholders get to take advantage of these benefits during times of medical emergencies or planned hospitalizations. The whole amount that they need to spend during the treatment is then covered by the insurers. All the top health insurance companies, in the country, provide this service.
- Settling Bills – During the duration of the hospitalization, policyholders do not need to pay anything and the insurers, represented by the Third Party Administrator(TPA), Coordinates with the cashless hospital(s) and settles the whole bill. However, you must ensure that in case you are going for a planned hospitalization, you have to inform your insurer in advance to avail the health benefit plans of cashless hospitalization.
The Procedure of Planned Hospitalization
In this particular case, when you buy health insurance online, you are able to pre-plan and find out the list of cashless hospitals in the network of your insurer. Planned health cover(s) allow for enough time on hand to decide on the affiliated network hospitals that you may want to get admitted in later on, based on your ailment. Planned hospitalization also means you can afford the time to fill up essential documents for admission to cashless hospitals, like “Pre-Authorization Forms”. All the hospitals in the network of your insurer, each have a dedicated “insurance desk” that takes care of all the policyholders. Keep in mind that there will be diseases that will not fall under the cover provided even under the best health insurance plan(s).
The steps to follow in the case to avail the benefits :
- Procure Pre-Authorisation – You need to ensure that you procure pre-authorization directly at the cashless hospital or you download it from the TPA official website. Go through the entire form properly and duly get it filled up by yourself(patient) and by your physician.
- Form Submission – Once the filling up part of the form is complete, it needs to be submitted to the insurance desk. There it will undergo a set of thorough reviews to consider its authenticity.
- Approval from the TPA – After submitting the form, it is sent to the TPA so that the TPA can put their mark of approval on it.
- Authorization Sent – In the last step of these cashless health benefit plans after the TPA put their approval on the form, and authorization holding the details of the total sanctioned amount is sent to the cashless hospital. The treatment will only start once that reaches the hospital.
The Procedure of Emergency Hospitalization
In case of emergency hospitalization, the policyholder must be attentive and needs approval for the cashless scheme within 24 hours from the time of hospitalization. You must repeat this procedure when it comes to filling up the emergency hospitalization Pre-Authorisation Forms. The same goes for getting approval from the TPA or Third Party Administrator. The TPA is bound by law to provide a reaction to said request form(giving approval or rejecting it) within 6 hours of the form being sent so that the treatment can progress for the patient. The biggest benefit in this case, when you buy health insurance online, is that the policyholder is at liberty to pay the medical bills at the hospital himself/herself and claim the entire amount later on from the insurer.
The steps to follow to claim the benefits :
- Insurance Card – Keep your health insurance card on hand, which holds the policy number and other details regarding the kind of health coverage that you purchased.
- Authorization Form – Fill the authorization form that can be found at the insurance desk so as to make the process faster.
- Stipulated Time Period – Ensure that you intimate the emergency hospitalization to your insurer inside the stipulated time period. The necessary details can be found on the policy document.
Benefits of Cashless Hospitals
- Peace of Mind – No need to worry regarding finances for hospitalization be it pre-planned or emergency.
- Quality Treatment – You can rest assured that you will always receive the top quality medical treatment, once you are covered.
Cashless Hospitalization Insurance, especially when taken from the best health insurance companies, can be a boon, but ensure that you peruse the terms and conditions of your policy carefully and research the inclusions and exclusions so that there are no unwanted surprises. You also must retain copies of all bills, reports, claim forms, discharge papers, etc. in case you need them later on.