Here, the insurer settles the medical bills directly with the hospital, you don’t have to stress about arranging money or tedious paperwork. You can make a cashless claim only if you get treated at a network hospital, i.e., a hospital listed with your insurer.
Follow these steps to make a cashless claim -
Check whether the hospital offers a cashless claim facility. If it does, get a list of documents you need to submit to them, such as a copy of the insurance policy, proof of identity, etc.
The next step is pre-authorisation, in which the hospital insurance desk contacts the insurance company for initial approval of medical expenses. Keep in mind that there may be delays in the approval process, so you should have some handy money in case you really need to commence the treatment.
As soon as you know the discharge date, get all bills ready for final approval by contacting the hospital insurance desk. This way you can ensure claims are processed more quickly without any delay.
The insurance company will verify all documents and bills and give their final approval within 2 to 6 hours. The final approval may take longer than expected for various reasons. Therefore, you can decide whether to wait until the claim is approved or to pay the bill upfront and get reimbursed by your insurer later.
Insurers will provide you with a claim settlement summary that specifies -
Whether a claim has been approved or denied.
All the expenses incurred during your treatment.
Approved and unapproved expenses.
You should then carefully go through this summary. Contact your insurance company if you have any questions or can see errors.
Reimbursement Claim Process
Here’s how a reimbursement claim process will work:
The first step is to notify your insurance company that you are admitted to the hospital.
If you have chosen a non-network hospital for a planned treatment, you will need to notify the insurer (by their toll-free, email, or SMS) as quickly as you can.
If you have chosen a non-network hospital for an unplanned treatment, you need to inform them within 24 hours of getting hospitalised.
Make sure to organise your hospital bills and receipts carefully. You will need to submit them to your insurance company along with the required documents and a duly filled-out claim form.
The insurance company may require you to submit additional documents or missed documents, so make sure you give them to them as soon as possible.
It is also necessary to respond promptly to any queries put forth by the insurer during the approval process.
After your claim has been approved by the insurer, you will receive a claim settlement summary listing the reimbursement amount, deductions made, and expenses approved and rejected. If you find any errors, you can clarify the same with the insurer.
You will then receive the reimbursement amount in the bank account you specified on the claim form.