Recent changes in health insurance policies have made it easier for policyholders to get cashless treatment, even at non-network hospitals. Earlier, cashless treatment was only available in-network hospitals, but with these updates, you can now access treatment at any hospital without the need for advance payment. Here’s a simple guide on how this new benefit works and what you need to know to make the most of it.
Check If Your Policy Supports the New Rules
Before assuming that you can avail of cashless treatment anywhere, it’s important to check whether your health insurance policy has been updated with these changes. Some policies may need to be upgraded or adjusted. Speak to your insurance provider to confirm whether your current plan supports cashless treatment in non-network hospitals and what limitations may apply.
Pre-Authorization Is Required
To get cashless treatment at a non-network hospital, pre-authorization is crucial. This step ensures that you don’t have to pay out of pocket for the treatment. Either you or the hospital must inform the insurance company before or shortly after hospitalization. The insurance provider will review the medical details and estimated treatment costs before approving.
Steps for Pre-Authorization
The pre-authorization process is straightforward. You or the hospital will need to send the following to the insurance company:
- Health insurance card or policy details
- Valid ID proof like Aadhaar or PAN card
- Medical report and doctor’s prescription
- Estimated cost of the treatment from the hospital
Once these documents are submitted, the insurance company typically responds within an hour. Upon approval, the treatment can proceed without advance payment.
Keep Your Documents Ready
To ensure the process goes smoothly, have these documents prepared:
- Health insurance card or policy number
- Valid identification (Aadhaar card, PAN card, etc.)
- All relevant medical reports, including the doctor’s prescription and test results
- The hospital’s treatment cost estimate
These documents are critical for quick approval and seamless cashless treatment.
Emergency Situations
If you’re in an emergency, don’t worry—some insurance companies allow post-treatment authorization. This means you can get treated immediately and seek approval later. However, you must inform the insurance company within 24 hours of being admitted to the hospital for the claim to be valid.
Role of the TPA Desk in Hospitals
Most hospitals have a Third-Party Administrator (TPA) desk, which acts as a bridge between the patient, the hospital, and the insurance provider. The TPA desk helps you navigate the cashless treatment process, ensuring your claims are processed efficiently. They can also guide you on what expenses will be covered by the insurance and any additional costs you might need to bear.
With these new health insurance rules, getting cashless treatment has become more accessible, even in hospitals outside your insurance provider’s network. By following the right steps and keeping the necessary documents ready, you can enjoy the convenience of hassle-free healthcare without worrying about advance payments.
