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Your easy guide to avail cashless Hospitalization
Do all Health Insurance Policies offer cashless hospitalization facility?
Today, most Health Insurance policies do offer cashless hospitalization facility and route your policy through a Third party Administrator (TPA). However you should be familiar with the terms- Network Hospital and Non-network Hospital.
Network Hospitals are those hospitals that your TPA has an agreement with. In case of hospitalization, if you get admitted to a Network Hospital you will be eligible for cashless hospitalization, subject to the other terms and conditions mentioned in your policy being fulfilled. In case you are admitted to a Non-network Hospital, you will have to settle the bills directly to the hospital and then seek re-imbursement through your TPA.
Does cashless hospitalization mean I can just walk into a hospital and get admitted for treatment free of cost?
First, you need to be clear that there is no free treatment. It is just that, in the case of a cashless hospitalization, the insurance company will bear the cost of treatment either fully or partially on your behalf.
Cashless hospitalization is a facility provided by most health insurance policies and enables an insured customer to obtain admission and undergo the required treatment without a direct payment. The assigned TPA will mediate between the healthcare service provider (Hospital) and the Insurance company and settle the bills on behalf of the insured customer.
However it is important to understand the role of a Hospital in cashless hospitalization. The Hospital is only a facilitator and has no authority to approve or disapprove any request for cashless hospitalization. Certain protocols laid down by the Insurance Regulatory and Development Authority (IRDA) with respect to cashless hospitalization will need to be adhered to strictly.
What procedures should I follow to avail the facility of cashless hospitalization at Sanjeevani?
Hospitalization happen fewer than two circumstances – Planned and Emergency. Pre-authorization approval of the estimated hospital expense is a must to avail this facility.
In the case of a planned admission, you would have first consulted a doctor who in turn would have advised you on the probable date of hospitalization. In such a case, you must have applied for an approval of the estimated hospital expenses directly with your TPA at least 4-5 days prior to the date of hospitalization.
In case you have not applied for a pre-authorization sufficiently in advance or if the doctor treating you advises you to get hospitalized immediately after the consultation, our Insurance Cell will assist you through the pre-authorization procedure.
However, you will need to bear in mind that the Insurance Cell is only a facilitator and can in no way influence the decision on the approval. The approval can be turned down.