Saturday, March 12, 2011

Cashless Hospitalization in Health Insurance

In the previous chapter on Health Insurance, I had used the term Cashless Hospitalization. Some of you may have understood what it meant or even used it but there are a few who may not know what it is. Well, the purpose of this article is to understand what Cashless Hospitalization is and how it is useful.

So, lets get started!!!

What is Cashless Hospitalization?

Cashless Hospitalization is a facility using which a person who holds a health insurance policy can get admitted in a hospital and get himself treated without having to pay for all the medical expenses. There are a few things that the insurance does not cover, which the person would have to pay for, but otherwise the insurance company will pay for the rest of the expenses.
Convenient, Right???

How Cashless Hospitalization works?

Let us take an example situation and try to figure out how it works. Let’s say our Uncle Sam has suffered a Heart Attack and needs a Surgery to be done within the next 2 or 3 days. Luckily Uncle Sam has a medical insurance policy and his son is planning to use the cashless hospitalization facility to treat his father. This is how it will happen
Step 1: Uncle Sam’s son contacts the Hospital Reception, explains the situation and inquires about the cashless hospitalization facility.

Step 2: The Receptionist gives him a form to fill-up to request Cashless Hospitalization

Step 3: Uncle Sam’s son fills up the form, signs it and hands it over to the Receptionist

Step 4: The Hospital sends out the details to the Insurance company

Step 5: Officers at the Insurance company validate the documents and the details of the insurance policy. They check if Uncle Sam has enough coverage to pay for the hospitalization. Once they validate they send out a response to the Hospital.

A point to note here is that, the company would send out details of the amount they would pay for the treatment, and the kind of expenses they wouldn’t pay. For Ex: They can say that, Uncle Sams policy covers upto Rs. 2 lacs of treatment and we will not pay for Air Conditioned rooms and food expenses. The rest of the treatment upto Rs. 2 lacs is covered.

Step 6: The Hospital receives the communication from the insurer and shares the news with Uncle Sam’s son.

Step 7: They ask him to sign an agreement that, whatever expenses are not covered would be paid by him before Uncle Sam is discharged

Step 8: After he signs the agreement, the hospital will begin Uncle Sam’s treatment

Step 9: Uncle Sams treatment is over and he is getting discharged today. His son is going to pay the balance amount due to the hospital and take his healthy dad home...

What are the Documents you need for Getting Cashless Hospitalization?

The following are the documents you need for getting or rather using Cashless Hospitalization facility. They are:

1. Identity Proof – like Drivers License, Passport (This is used to validate that the person asking for the feature is indeed the person who is covered by the insurance policy)
2. Insurance Proof – Usually an Insurance Card or a Policy Document (This is used to validate that the person has a valid insurance policy and is currently active as on the current date)
3. Proof of Sickness – Usually a letter or certificate from a Doctor who is treating the patient
4. Proof of Treatment – Usually a letter or certificate from the Hospital that the patient is being treated in their premises

An important point to note here is that, almost all insurance companies and policies have the cashless hospitalization facility. It is better if you confirm with the insurance agent about the availability of this feature before you sign-up for the policy.

Because, better safe than sorry!!!

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