What are the Steps to obtain Seamless Medical Treatment?
Introduction:
The important lessons that the COVID-19 pandemic has taught people are that the health condition of a person is uncertain, and medical emergencies are unpredictable. So, it is always wiser and advisable to be financially prepared to avoid additional stress during a medical crisis. Also, The easiest way of preparing oneself for unexpected situations is by insuring themselves. By doing so, one can at least stop worrying about money and focus on availing high-quality treatment in the best hospital.
Earlier the health insurance policies are purchased, better for the insured. Almost all the insurance companies have started offering cashless Mediclaim policies these days. Why undergo a hassle claim settlement process, especially when the insured exhausted both physically and mentally when they have a hassle-free cashless claim?
Understanding cashless mediclaim policy:
Of the many pressing reasons to purchase a medical insurance policy, an important thing is that it offers financial security to a person during an emergency. Though claiming a settlement has become comparatively stress-free in recent times, it involves a lot of paperwork. Also, To make the entire process hassle-free and seamless, insurers have extended their list of network hospitals to offer cashless Mediclaim.
A Cashless Mediclaim policy is a type of medical insurance policy in which the insurer pays the hospitalization charges and other medical expenses directly to the insured’s hospital. It means that one does not have to pay from their pocket. So, the insured need not worry about arranging money to pay at the hospital; and then reimburse it from the insurance companies. Also, Insurers will have tie-ups with various hospitals, which called the insurer’s network hospitals. Since this facility can availed only at the insurer’s network hospital; its always advised to choose a health insurance company that has an extensive list of network hospitals.
Cashless Mediclaim can availed in cases of both planned and emergency hospitalization. Insured must also be aware of multiple clauses like waiting period, exclusion; copayment and sub-limits for treatment to avoid last-minute tension.
Documents required for cashless hospitalization:
Insured persons need to inform the insurance companies in advance in case of planned hospitalization or immediately after hospitalization in case of emergency to avail of cashless treatment at one of their network hospitals. Below are some of the important documents that need to submitted to the insurers.
1. Cashless hospitalization claim form filed and signed by the policyholder.
2. Medical insurance card.
3. A consultation letter from the doctor.
4. Original bills of hospitalization with a detailed cost break-up.
5. Lab and test reports
6. Original discharge summary.
7. Payment bills and invoices are provided at the pharmacy.
8. Copy of FIR if provided.
9. Valid ID proofs.
Steps for availing cashless claims:
Not many policyholders know or understand the procedure to make cashless claim at the time of a medical emergency. To avoid undergoing a hassle process coupled with emotional toll; its necessary to aware of the steps involved in making the settlement process.
1. Policyholders must get hospitalized in one of the network hospitals of the insurers to avail of the cashless Mediclaim.
2. The insurer or the Third-party Administrator (TPA) should be informed about the hospitalization as soon as possible. This will give the insurer sufficient time to process the request. In case of planned hospitalization, the insurer should informed in advance by submitting a pre-authorization form. The form can collected either at the hospital’s insurance desk or from the insurer/TPA.
3. Health ID and duly signed claim form should be submitted at the hospital along with other necessary documents to get the insured sum for the treatment.
4. After verification, the insurer will pay medical dues directly to the hospital.
Government intervention to increase the scope of cashing facilities:
Until a couple of years ago, the empanelment process for cashless service at hospitals was time-consuming and challenging as it involved multiple stages. Hospitals have to register with the Registry of Hospitals in the Network of Insurers (ROHINI); and obtain a certificate from the National Accreditation Board for Hospitals; and Healthcare Providers (NABH) or a state-level certificate from the National Health Systems Resources Centre (NHSRC).
To simplify the empanelment process, the Insurance Regulatory; and Development Authority of India (IRDAI) revised its guidelines on July 20, 2022. According to the revised guidelines, the insurance companies now empowered to empanel the hospitals that meet the benchmarks and criteria set up by the respective boards. It is to enhance the scope of offering cashless facilities across the country. It means that the insured will have a comprehensive list of network hospitals to access; and choose the provider of his choice.
Conclusion:
The cashless facility has been evolving every day. Insurers are also increasing the features of the policies to make them more attractive and convenient for policyholders. With a lot of options, it is necessary for the insured to read and understand the terms and conditions of the policy that suit their needs before purchasing one. This will prevent unwanted stress and hassle during medical emergencies.
