A medical emergency can occur anytime; your friend or relative might be in need of urgent hospitalisation in the oddest of hours. While admitting them to a reputed hospital/nursing home is the most crucial part of the job, the importance of having ready funds at your disposal cannot be stressed enough. Every health insurance plan is different and gives you various benefits in your everyday life. A Thrivent Financial Mdicare supplement plan review can help you decide which insurance plan fits you and your way of living depending on your job, your family status, your health, and other things. It’s essential to keep all the plans updated with any changes taking place either home or family-wise since your insurance will need to be altered based on your circumstances to fit your current needs.
Therefore, taking a little time out and investing your money beforehand in a comprehensive cashless mediclaim policy can be one of the wisest things to do. Besides guarding against such unexpected expenditure arising from an untoward circumstance, it takes off the financial worries completely, allowing you to stay focused on the bigger task at hand – that is the patient’s treatment.
Discussed below is a quick guide to a cashless health insurance policy:
What is the need for a cashless mediclaim policy?
Mental unrest can get the better of you while looking around for the best hospital to get your loved one admitted. It is during these times that cashless medical insurance policies can help you. Here are the various cashless medical plans:
(a) Cashless senior citizen health insurance
This plan is customised for the senior members of the family, covering a range of expenses such as hospitalisation charges, ambulance fees, and other associated medical expenditure. Senior members of the family, who could already be suffering from any critical disease, can enjoy the benefits of the coverage (depending on the policy terms and waiting period).
(b) Cashless family health insurance
A cashless health insurance for family lends complete coverage to both the policy holder as well as the family members.
How does a standard cashless hospitalisation plan work?
Health insurance providers tie up with network hospitals/nursing homes after probing into the quality of their medical services and negotiating on the charges of different procedures. In any of these network hospitals, your insurance provider (represented by the third-party administrator – TPA) will settle the bills.
You can avail cashless hospitalisation under either of the following scenarios:
Planned hospitalisation
Tips for you:
1. Go through the health insurance plan carefully and call on the toll-free number to enquire about the network hospitals
2. Once you have decided on the network hospital, take your policy card there and ask for the pre-authorization form. The first part of the form has to be filled out by the patient, whereas the attending doctor will fill the second part.
3. After having filled out the form, submit it at the hospital’s insurance desk. The concerned authority will validate its authenticity.
4. The form will then be sent to the TPA, that will then proceed to either approve it or cancel it.
5. In case it is approved, you will get an authorisation letter from the TPA, outlining the sanctioned health insurance amount.
Unplanned hospitalisation
During an emergency hospitalisation, you will need urgent medical attention. Remember to initiate the cashless mediclaim process within 24 hours of hospitalisation.
Tips for you:
1. Produce the health insurance card at the reception desk of the hospital. It will contain important details such as policy number, card number, details of the insurance provider and the type of policy.
2. Fill the pre-authorisation form, following which you might have to wait for a clearance from the TPA. However, should you need urgent care, you can pay the hospital bills then, and later get the same reimbursed from the insurance provider.
What isn’t covered by the cashless mediclaim policy?
Ambulance fees
Toiletry expenses
Attendant fees
Charges for oxygen masks, diapers, nebulizers, etc.
Documentation charges
Ancillary dietary expenses
Service charges
Remember These
1. You can enjoy the benefits of cashless mediclaim only with select network hospitals, already listed by your insurance provider.
2. You have all the right to ask for the details of every procedure the hospital undertakes.
3. Familiarise yourself with the policy and be sure about all the clauses enclosed therein
4. Remember that informing the TPA is a must – that’s because approval or rejection of the claim will depend on them.
5. While selecting the insurance provider, ensure you have a clear track record handy, detailing the ratio of claims getting approved or rejected by the company
6. Ask if your insurance company has a no-claim bonus policy
Reasons for rejection
It is advisable to keep a mental note of all the possible reasons that could lead to rejection of your claim. Listed
below are some of the more common grounds for rejection:
Your cashless medical insurance policy doesn’t accommodate the illness
You’ve already exhausted the entire sum assured
The details in the pre-authorisation form either don’t corroborate the reality or are insufficient for an approval
Delay in having intimated the TPA
Information about your pre-existing illness is incorrect or insufficient
