Forgoing health insurance can be a grave mistake in the face of escalating healthcare costs. When admitted to a network hospital without adequate financial means, they often borrow or take out loans, subsequently burdened with additional expenses due to loan interest. Health insurance emerges as a crucial safeguard against such financial strains, offering the assurance of affordable and high-quality medical care.
Understanding Network Hospitals
Upon purchasing a Bajaj Allianz health insurance plan for the family, policyholders are furnished with a list of network hospitals by the insurance company. This list is also accessible on the insurer’s website, outlining medical facilities that have entered into a partnership with the insurance provider. The primary advantage of network hospitals lies in their ability to provide cashless hospitalisation to the insured individual. This means that the policyholder is not required to arrange immediate financial support; instead, the health insurer settles all network hospital bills directly. Claims are subject to terms and conditions set forth under health insurance policy. *
Submitting Cashless Claims At Network Hospitals
Submitting a cashless health insurance claim at network hospitals involves three key parties: the insured person, the insurer or third-party administrator (TPA) acting on behalf of the health insurer, and the network hospital.
Planned Hospitalisation:
In cases where hospitalisation is scheduled in advance, the policyholder must initiate the process by presenting their health insurance card at the network hospital’s insurance desk. Subsequently, a pre-authorisation form, available for download from the insurer/TPA website or at the network hospital, must be filled out by both the insured and the attending physician. After completing the form, it undergoes accuracy verification at the insurance desk before being forwarded to the insurer or TPA. Upon approval, an authorisation letter stating the approved treatment amount is issued. On admission day, the insured presents the confirmation letter and health insurance card, and the insurance company pays the medical bills directly.
Emergency Hospitalisation:
For unplanned hospitalisations, the claim process starts within 24 hours of admission. The health card is presented upon arrival, and a pre-authorisation request is sent to the TPA a few hours after admission. Required documents include a completed form and an emergency certificate from the medical officer. The network hospital’s insurance desk speeds up the cashless claim process, and if urgent, the insured may cover initial costs upfront.
Reimbursement Claims
The insured can opt for a reimbursement claim if cashless hospitalisation is not possible. This involves gathering all medical bills, treatment costs, and reports. Upon discharge, the patient obtains a discharge summary or certificate from the network hospital, which is then submitted to the insurance company. After a thorough review, the insurer disburses the reimbursement for medical expenses based on the policy’s terms and conditions.
The cashless claim process offers financial relief, allowing patients to concentrate on recovery, confident that the insurance company will manage direct payments to the network hospital. Ensure that you carry out the process of health insurance renewal on time. Therefore, a careful review of the insurer’s network hospitals is recommended before acquiring health insurance, ensuring a smoother and more efficient healthcare experience when needed. Claims are subject to terms and conditions set forth under health insurance policy.
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*Standard T&C Apply
Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.
