Most of us do not visit a hospital by choice. We do go through emotional troubles during our visit to a hospital if somebody we love needs medical help. The last thing one needs at that time is to run around to arrange for the finances that come with the treatment. Medical Insurance is only thing that can take some of the pain away.
A Mediclaim policy offers coverage for expenses incurred by a person during hospitalization. The policy may offer 2 kinds of facilities: Cashless and Reimbursement claim
A Third-Party Administrator TPA is licensed by Insurance Regulatory (IRDAI) to process insurance claims under the Mediclaim policy. TPA is an intermediary between the Insurance company and Policy holder. A TPA can approve of a cashless claim settlement especially in case of planned hospitalization or reimburse it later.
If you are covered in the list of Insurance companies for medical services, SK Hospital will assist you getting the claim processed by your Insurance company or Third-Party Administrator (TPA)
List of Insurance companies
SK hospital has tied up with the following institutions/ insurance companies and TPAs for your convenience
A doctor when providing a treatment plan will suggest a tentative date of hospitalization. In such a case an approval of estimated hospital expenses can be taken up with the insurance company/TPA, prior to the date of hospitalization.
In cases where a doctor advises on immediate hospitalization after consultation the Insurance cell at the hospital can assist through the pre-authorization procedure.
Note: The Insurance cell is only a facilitator and cannot influence the decision on the approval
The typical steps during pre-authorization are listed here
The insurance cell will take up the case on a fast-track basis with insurance company/TPA to receive approvals within 3 hours during a working day in case of emergency hospitalization. In case of delay in approval and due to the medical emergency treatment can be availed by paying the necessary cash deposit. Refund of the cash deposit is made once the insurance company/TPA approves the claim.
It is always safe to first get the approval before hospitalization.
The request for approval could be rejected due to the following reasons
Enhancement of Pre-approved amount
The insurance cell will apply for an enhancement in case the hospital expenses exceed the pre-approved amount. If the insurance company/TPA does not approve the new amount the patient will have to pay the excess amount by sending interim bill and treatment summary+.
Expense not covered under Insurance
There are some expenses that may typically not be reimbursable. These are:
Discharge Process and Insurance settlement:
The discharge process takes between 6 to 8 hours for a person who has medical insurance. The claims settlement process depends on the administrative efficiency of the hospital and insurer. A proactive approach by the patient/bystander could speed up the settlement and hence shorten the hospital discharge time considerably.
A few things that can be done to speed up the process are: