Day Care Procedures
Let us say you visit a hospital, undergo a minor surgery like Lithotripsy (Kidney Stone Removal) but do not need to stay at the hospital. Do you pay in cash for such a surgery? Or can you use your Cashless Health Plan? Yes you can avail this facility. You need to file such a claim in the same manner as you would any other claim. Most companies today mention a list of procedures that are covered in the cashless facility even though it does not require hospitalization. This is because scientific advancements have made many procedures simpler today. Other than Lithotripsy, the list may contain procedures such as Haemodialysis, Radiotherapy, Chemotherapy, Dental Surgery, Eye surgery, Tonsillectomy and a host of others. For example LIC Jeevan Arogya considers 140 day care procedures. But plan ahead of the surgery, inform the TPA (Third party administrator) and get their approval for the procedure.
Know your list of network hospitals. Your cashless policy can only be used if you are treated in one of the hospitals approved by the TPA. When buying the policy you should have been given this list. At most of the network hospitals, there will be a TPA desk, which helps you with all the forms and procedures that are needed for a cashless claim. The insurance company will then settle all the bill with the hospital and you need not pay for your expenses. If treatment is taken outside a network hospital then you will have to pay for all the expenses and later get it reimbursed from your insurer. However note that most insurers do not pay the whole amount if treated outside their network hospital.
All plans have a maximum number of days in hospital covered under the cashless plan and also the maximum amount for rooms per day. Some even differentiate between ICU stay and Non ICU stay. Some have a different cap per year and also a lifetime cap. Hence if you know your procedure will take place after a few days, consult with your doctor and check whether you can get admitted later.
This is the most important and often overlooked part of the cashless procedure. Firstly make sure you have the TPA approval. Have all the diagnosis results, and the doctor's advice summary. Check that the bills do not have any items as miscellaneous or sundry or others. Make sure the hospital gives a complete break-down of every expense in the total amount. Finally have the discharge summary and fitness certificate ready as without this you cannot even start your cashless claim.
If you hold a Cashless Health Plan, read the terms carefully. Do not delay in filling up the necessary forms and get the TPA approval as early as possible if you do not wish to unnecessarily pay from your own pocket.
Written By: Deepak Yohannan
The author is the CEO of MyInsuranceClub.com, an online insurance price & features comparison portal
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