In Any Health Insurance Claim There Are Two Ways. First, Cashless. Second, The Reimbursement Process.
Health Insurance
Health insurance is Very Important In Everyone’s Life. This Type Of Insurance Plays The Role Of Savior During Any Health Crisis. From Hospital Expenses, Drug Costs To Ancillary Tests, Everything Is Covered By Health Insurance. But An Insurance Is Not only Bought And Kept. It Is Important To Know How To Claim That Health Insurance When Needed.
In Any Health Insurance Claim There Are Two Ways. First, Cashless. Second, The Reimbursement Process. However, Both These Methods Have To Follow Some Rules.
Cashless Or Cashless Method
Some Hospitals Or Nursing Homes Are Affiliated With Any Insurance Company. These are Called ‘Network Hospitals’ In Insurance Parlance. If You Are Admitted to a Network Hospital Or Nursing Home With Which You Have Purchased Health Insurance, There Is No Cash Payment For Medical Expenses. But In That Case The Number Is Absolutely Zero, But Not That. Apart From Medical Bills, Some Non-medical Receipts Require A Very Small Deposit. Treatment Under This Type Of Health Insurance Is Very Easy.
Things to keep in mind for cashless claims—
1. Different medical institutions have different rules. For example, the cashless claim type is the same for a single person in a hospital. Again the type of Claim Is Different In Case Of Corporate Group Policy. So First you need to Know What The Claim Process is According To The Type Of Policy.
2. After The Patient Is Admitted To The Hospital, Several Documents Have To Be Submitted To The Claim Department of the Respective Hospital. For Example, KYC, policy Copy, Doctor’s Prescription Etc.
3. Check Whether Your Policy Has Any Capping Clause Or Co-pay Clause At The Time Of Taking The Policy. This CAPPING CLAUSE OR CO-PAY CLAUSE Means That The Insurance Company Pays You A Certain Percentage Of The Medical Expenses. You Have To Pay The Remaining Amount Yourself. If There Are Any Such Conditions Then First Know Exactly How Much Money You Have To Deposit.
4. Hospitals or Nursing Homes Affiliated With Insurance companies Vary From Time To Time depending on the Contract. So, Before Admitting the Patient, Find Out Whether The Concerned Hospital Or nursing home is Part Of The Network Hospital of That Organization Or Not.
5. Many times there is a delay in documenting the claim and final approval of the claim. But in the Meantime, According To The Physical condition of the patient’s body, IMMEDIATE Treatment Or Operation May Be Required. At That Time, However, The Hospital Had to Deposit Some Cash in Advance. However, The Money Can Be Refunded Later.
6. Although the entire process is cashless, Some Expenses Are Incurred Before And After Hospitalization. To Get That Money Back, You Have To Apply Again With The Necessary Documents Later.
Reimbursement Procedures
Many Times If For Some Reason It Is Not Possible To Be Admitted To The Network Hospital Of The Insurance Company, Then The Hospital Or Nursing Home Where He Is Admitted, Completes The Treatment And Submits All The Medical Bills, Receipts, Documents, Prescriptions And Medical Test Reports Etc. To That Company. After Analyzing These Required Documents, The Company Remits the Money To The Insurance Customer’s Account.
Things To Keep In Mind Regarding Reimbursement Procedure—
1.The Entire Cost Of Medicines Or Tests Can Be Claimed Under The Reimbursement System From Pre-hospitalization To Post-hospital Discharge.
2. If Any Treatment Is Planned In Advance, All The Documents Should be Submitted To The Policy Department Of The Concerned Hospital At Least 24 to 48 Hours Before Admission. On The Other Hand, In Case Of Sudden Admission Due To An Emergency, The Insurance Company Should Be Informed About The Admission within 24 Hours Of Admission.
Remember That Just As Insurance Helps in Times Of Crisis, Not Providing Correct Information At The Time Of Insuring Or Concealing Any information Can Lead To Problems In Getting Insurance Payouts Later. And Definitely Read All The Insurance Documents And Information Before Insuring.
