Medical emergencies can strike at the most inconvenient times – late at night while sleeping, during an afternoon at the office, whenever we least expect it. In those panic-filled moments, our only thought is getting a loved one to urgent medical care as quickly as possible. Rushing to the ER feels automatic. The logistics of insurance paperwork and cashless approvals couldn’t be further from our minds when a family member’s health hangs in the balance.
Even though your hands and feet are cold and paralysed with fear and tension, you might still have to make monetary arrangements. But if you have the feature of cashless hospitalisation with your insurance policy, medical expenses won’t trouble you.
As long as you have the cashless feature with your health insurance, you won’t have to spend a single penny to treat your loved ones at the best facilities. Your insurer will directly settle the medical expenses with the healthcare facility while you hold the hands of your loved ones and provide them with mental support to recover faster.
But the cashless feature will be available only when you take your loved ones to a hospital in your insurer’s network. Jump into this article to learn in detail about cashless hospitalisation and how you seek treatment under this special feature:
Cashless Hospitalization Process
If you have the cashless feature with your individual health insurance policy, the insurer will handle the financial aspect. The insurance company will appoint a TPA (third-party administrator) to contact the hospital to settle your dues directly. The cashless policy is available in case of planned and emergency hospitalisation. Let’s see how the cashless feature works in the two scenarios:
1. Planned Hospitalization
With planned hospitalisation, you already have an idea that you need to be admitted within the next few days. In this scenario, you must pick a network hospital for your treatment. Consider your specific treatment needs before choosing the right facility for medical services.
Once you are done choosing the network hospital, you will have to abide by these steps for cashless hospitalisation:
Submit your insurance policy card to the chosen hospital to acquire a pre-authorization form. Usually, these applications are available at a hospital’s insurance desk. You might also download it from your insurance provider’s official portal.
- Submit the duly filled pre-authorization form at the insurance desk of the network hospital. The authorities will thoroughly inspect the application to determine its authenticity.
- Next, the hospital will send the form to the TPA, who will process the pre-authorization request.
- If your insurer accepts the pre-authorization request, the TPA sends an authorisation letter. This letter contains information regarding the sanctioned amount for treatment expenditure.
2. Emergency Hospitalization
If you need emergency hospitalisation, it means that the need for medical care is immediate. In this scenario, policyholders can raise the cashless health insurance facility within 24 hours of admission to a hospital. You will be able to utilise the cashless facility during emergency hospitalisation through the following steps:
- Submit your health insurance policy card at the network hospital. The card must reveal details regarding your policy number, insurer’s name, and type of health plan.
- Next, fill in the pre-authorization form and make the person at the insurance desk initiate the claim process. However, waiting for TPA approval might not be possible in case of emergency hospitalisation. In such a situation, you can always pay the bills from your pocket and wait for reimbursement.
- According to protocols related to emergency situations, a TPA needs to process emergency hospitalisation claims within a maximum of 6 hours.
Treatment Under Cashless Hospitalization
With ACKO, you will discover many policies that support treatment with the cashless facility. ACKO plans offer zero deductions on claims. So, all the charges listed below are covered. This includes:
- Hospital services charges
- Fees of the attendant
- Ambulance charges
- Non-medical expenses
- Documentation tasks
But remember that even if you have the cashless features, your insurer might reject the claim. You should provide accurate information in the pre-authorization form to get approval from the TPA. Moreover, keep all documents like medical bills and pre-authorization forms related to cashless treatment.
Summing up
If you have the cashless feature with your health insurance policy, you don’t have to worry about making financial arrangements during a medical emergency. So, enjoy convenience and peace of mind with a cashless health insurance plan.
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