If sudden illness or medical injury is the worst things in anyone’s life, then the huge cost incurred as a result, is nothing less than making it appalling. Very often people rush to the nearest ATM or borrow from friends and relatives for meeting up the initial deposits but in the long run it does not help. Therefore, the best way out is to get a Cashless mediclaim policy, which if managed properly can be a big relief during such unexpected medical emergencies.
The concept of cashless mediclaim came into existence with values added under Health Insurance after the introduction of TPA concept. TPA refers to the professional medical experts, who are appointed to create relationships with hospitals, to discuss on rates for treatments on direct billing and payment arrangements.
Before the introduction of cashless policy, mediclaim policyholders were supposed to pay the hospital for their treatment and then submit bills to the insurance company for reimbursement. After the introduction of Cashless mediclaim, the mediclaim holder does not need to pay cash directly to the hospitals. It is a is a mechanism where the TPA or the Insurance Company has a direct arrangement with a set of hospitals (which are collectively called network hospitals) for direct billing and payment of bills according to the terms and conditions of the policy. With cashless mediclaim, the policyholders are at the comfortable position to be an insured individual and if the emergency crops up, they can get hospitalized with a network hospital without bothering about settling the hospital bill.
To understand the concept of cashless mediclaim properly, you have to be well aware about the mechanism of its work. First, Health insurance providers establish contracts with a set of hospitals after reviewing the facilities, quality of service, and negotiate the surgery or treatment wise rates with them. Cashless service is available only to those hospitals, which are in the network of a particular Health insurance provider. To know the list of all the hospitals which are included in your health insurance provider’s network, you can check the name of your TPA (Third Party Administrators) mentioned in your policy and accordingly visit its websites or call their toll free number to have a personal talk with them.
For the application of the cashless mediclaim, the customer has to inform the admission desk or the Insurance desk of the Hospital about the Insurance Coverage. He may also need to fill a pre-authorization form and ensure signatures at appropriate places supervised by authorized personnel in the hospital. Then it is the hospital’s responsibility to send a fax of the pre-authorization form for approval to the Cashless team of the Insurance provider.
The Cashless team Insurance provider may approve or deny the claim according to the terms and conditions of the policy. After approving the form, the cashless team will send an authorization note by fax, mentioning the initial amount authorized. This is the amount, which the Insurance provider is bound to send to the Hospital. The same is applicable during the discharge also. The customer has to bear the amount, which is not authorized.