Take Care Of The Following Steps -
Process The Paperwork In Advance
In case of a planned hospitalisation, submit the form at least 3-4 days prior to the admission.
If you are the patient, to prevent avoidable delays, send in a responsible family member to complete the paperwork before you get to the hospital.
In case of emergency hospitalisation, submit the form within 24 hours of hospitalisation.
Track The Progress
Upon submission of the pre-authorization form, you can track the progress on the TPA app or website.
Answer all queries raised by the insurer at the earliest, which will ensure an uninterrupted claim settlement.
An insurance company can delay or reject an authorization, if the documents are not submitted or the queries are not answered. In such a case, you will have to go for the reimbursement process.
Keep copies of all documents submitted
Ensure that you have a soft-copy (or at least photocopies) of every document you submit, as the insurer might ask for them later.
Track The Billing Everyday
With a clear picture of how much the final bills could be, you can then either inform the insurer of any additional charges, or use another policy if the current coverage is insufficient.
Keep A Record Of All Pre-Hospitalization Expenses
Medical expenses incurred before the hospitalisation will have to be claimed separately with the insurer.
Store all the original prescriptions, bills/receipts, reports (including films) that led to the hospitalisation, since these can be claimed separately.
It is also important to have prescriptions from the first doctor you visited, with the problem that led to this hospitalisation. especially if they are from another hospital/clinic.
Keep Medicine Bills After Purchase
If you purchase medications at the hospital counter, even before getting discharged, they too will get covered under cashless claim.
Be Prepared For The Final Billing
Once the doctor finalises your discharge date, check with the hospital insurance desk, and submit the final paperwork (including the final bill and discharge summary) to the insurance company. Do this as early as possible.
If any documents are still pending, the insurance company will notify you. Track the progress through the insurance company's online tracker, and submit the missing documents at the earliest.
Once all the papers are submitted, it will usually take between 2 to 6 hours to receive an approval from the insurer.
In case the final approval does not arrive or is delayed, you may have to wait at the hospital, or pay upfront and claim the amount later as reimbursement.
Learn About The Claim Approval Process
As per the terms and conditions of your insurance plan, approved claims will show an account of the expenses approved and unapproved .
You need to read through the claim settlement summary carefully.
Expenses such as co-payment, proportionate deduction, exclusion for consumables, etc. need to be borne by you.
For example, if your insurance policy has a co-pay (or co-insurance) clause of 15% and your medical expenditure has amounted to Rs.60,000, you will have to pay Rs. 4,000 out of your own pocket, and the insurer will cover the remaining Rs. 56,000.
Hospitals may keep some deposit with them even after your discharge, as retention money, till they receive their payout from your insurer. Save this receipt and collect the refund once the payout has been made.