Cashless health insurance: How to ensure smooth and timely approval of your claim?

Date : 08/12/2021
Read: 4 mins

Read in हिंदी: कैशलेस स्वास्थ्य बीमा का दावा आसानी से कैसे पाएं

Here is a 6-step procedure, which, if followed to the tee, can smoothen out your claim experience. If you also wish to know the step-by-step procedure, read on to know more...

Steps for a smooth cashless health insurance claim experience

Health insurance companies offer cashless health insurance wherein they directly handle the hospital bills, and you don’t feel the financial pinch. Insurance companies have also simplified their claim process to make it easier for you to make a cashless claim. However, in cases of emergency, the claim settlement process might feel overwhelming.

So, here are some simple steps for a smooth claim experience.

Step 1 - Locate a network hospital

The first step to avail of a cashless facility is to locate a network hospital wherein such a facility is available. The list of hospitals can be checked from the insurer’s website or through its claim department. Check and choose a preferred hospital for cashless hospitalisation.

Step 2 - Inform the insurance company or its TPA

Informing the insurer of the claim is crucial as it allows the company to register your claim and then give a subsequent approval. So, inform the insurer or its TPA (Third Party Administrator) of your cashless insurance claim.

Tip: Send a written intimation so that you have proof of the same in case the need arises!

Step 3 - Fill and submit the pre-authorisation claim form
For availing of approval for cashless medical insurance, you need to fill and submit the pre-authorisation form. The form is available at the insurer’s office, website and even at the hospital desk. In case of pre-planned hospitalisation, follow your insurer's guidelines on intimation/pre-approval of hospitalisation and the cashless coverage amount. In case of emergency admission, inform your insurer within 24 hours of hospitalisation. Based on this form, the insurer would approve the cashless claim.

Step 4 - Check the room rent capping

Some health plans limit the coverage for hospital room rent. If there is capping in your policy, opt for a room whose rent falls within the allowed limit. If the actual room rent is higher than the allowed limit, the whole hospitalisation claim would be underpaid on a pro-rated basis, and you would incur out-of-pocket expenses.

Step 5 - Understand the exclusions and co-payments

Health insurance policies have some key exclusions wherein the claim is not payable. So, check the exclusion list of your health insurance plan. If you are treated for excluded coverage, do not make a claim as it would be rejected.

Furthermore, there might be co-payments in the plan wherein a specific part of the medical expenses would be borne by you. Check for the co-payment clause and pay your share at the time of discharge and final bill settlement.

Step 6 - Keep the identity proof and policy document handy

Lastly, documentation is crucial. When you are being admitted to the hospital, you need to provide identity proof so that your identity can be authenticated. Moreover, the health card of your insurance policy or the policy number is also needed at the time of hospitalisation. So, keep your policy bond and identity proof handy.

Once you are hospitalised, the TPA desk at the hospital will do all the paperwork. All you need to do is follow up with them so that there are no pending documents, reports, clarification, etc., which might delay the settlement of the claim and thus delay the discharge!

To wrap it up:

With these steps, the claim in your cashless health insurance policy would be settled without any hassle. If you have any queries on how to claim health insurance, call up the health insurance company. Make your health insurance claim a breeze and get financial assistance when you need it the most.