India News Get -BusinessChanges in Health Insurance Rules Explained; Cashless processing | Out-of-network hospital
archive photo
Recent updates to health insurance rules have increased the scope of cashless treatments. Now, policyholders are allowed to seek treatment even at out-of-network hospitals without paying upfront. Let’s understand how health insurance holders can avail cashless treatment at any hospital
Understand your policy: First of all, check whether your health insurance policy has been updated with the new changes or not. Some policies may require upgrades or adjustments to facilitate cashless treatments at out-of-network hospitals. Also get information about items not included in the policy and its limits.Pre-approval process: You can now get cashless care at out-of-network hospitals, but it requires prior authorization. This is an important step in avoiding out-of-pocket expenses. Before or shortly after hospitalization, you or the hospital must notify the insurance company, who will review the treatment plan and cost estimate.Pre-authorization steps: Send the health insurance card, valid identity card, medical report and the estimated cost of hospital treatment to the insurance company. Wait for approval. Insurance companies usually respond within an hour.Keep documents ready: Prepare the following documents for the pre-authorization process and smooth completion of your application: health insurance card or policy details, valid identity proof (Aadhar card, PAN card, etc.), medical report including the doctor’s prescription and all tests. The results must be understood. Apart from this, there should also be an evaluation of the hospital’s treatment.Emergency cases: In case of emergency, some insurance companies issue an authorization after treatment. This allows for immediate processing and approval later. To benefit from this benefit, the insurance company must be informed within 24 hours of hospitalization.Get help from the hospital TPA office: Most hospitals have a third-party administrator office or TPA office. The TPA desk acts as an intermediary between you, the hospital and the insurance company. TPA Desk provides a free service to obtain treatment and handle complaints based on your health policy. Here you will get advice on what expenses will be covered by the claim and how much you will have to pay out of pocket.