Insurance Savvy

Do's and don'ts of cashless and non-cashless
hospitalisation.

Cashless hospitalization is a service provided by an insurer wherein you are not required to settle the hospitalization expenses at the time of discharge from hospital. The settlement is done directly by the insurance company. However, prior approval is required from the TPA before the patient is admitted into the hospital. This service can be availed of during both planned and emergency admission.

Do's

• Intimate your TPA before admission to network hospital
• Ensure that you have ID Card at the time of admission to a hospital
• Provide complete information in prescribed format
• Carry necessary medical and investigation reports
• Register / reserve your admission as per the selected hospital’s procedure for admission
• Adhere to the procedural formalities of the hospital

Don'ts

• Don’t claim the following expenses:
• Telephone \ Fax.
• Food & Beverages.
• Toiletries & Cosmetic items.
• Attendant charges.
• Don’t conceal or misrepresent any health/medical condition

A non-cashless claim is when you avail treatment in hospitals that do not form part of insurer’s network or when you avail treatment in insurer’s network but do not avail cashless facility, but subsequently claim reimbursement from the insuer.

Do's

• Forward all the relevant reports and documents in original for claim on reimbursement basis
• Always keep a copy of all medical records for future use
• If you submit documents through courier, please keep a track of proof of delivery.
• Insist and obtain detailed discharge summary and all medical reports from the hospital.
• Ensure that all columns of the claim form are duly filled and all documents as per the checklist provided is submitted
• In case of surgeon / consultants bills, insist on a stamped, sealed, numbered receipt.

Don'ts

• Don’t accept undated, unnamed bills from pharmacists/laboratories
• Don’t conceal or misrepresent any health/medical condition.

You can stick to the following rules to prevent disappointment over a claim -

1. Read the list of coverage and exclusions in policy wordings (which comes to you with the policy).
2. Ensure that you declare all the pre-existing diseases at the time of enrolment.
3. Do not claim for any hospitalisation and diagnostic studies / investigation charges, which do not confirm existence of an illness or injury that requires hospitalisation.
4. Submit your claim well within the time frame set out in the policy. Insurers reject claim on the grounds of late submission.
5. Understand your policy in detail. Be informed about the ‘Fine print’, exclusions and details pertaining to exclusions and deductions.No Insurance company shall be able to pay beyond what is provided in the policy
6. Do not hesitate to ask details of deductions or rejections.

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