How to Make a Cashless claim In Mediclaim Policy

If you are having a Mediclaim Policy, you would surely want to know how to raise claim for the same in future. Below discussed are the two ways how you can make claim:

  • Cashless wherein the Insurance Company makes payment to Hospitals directly. In this case, you shall need to bear the Non-Medical expenses and other charges if there is any capping as per policy terms and condition.
  • Reimbursement wherein you need to pay to the Hospital for the treatment taken and submit the documents to Insurance Company/TPA for reimbursement of medical expenses incurred for the treatment.

Let's have a look at the Cashless Claim Procedure in this post:

  • Cashless can be taken only in a network/empaneled Hospital.
  • You need to check with your Insurance company or TPA for the list of Network Hospitals.
  • In case of planned Hospitalization, once Network Hospital is finalized, visit the TPA Desk/Billing Counter of the Network Hospital, provide them your Health ID card/TPA card and Patient Photo ID card, in return, they will Provide a cashless/Pre-Authorization form wherein the Basic details needs to be filled and submitted back to the TPA/Billing department.
  • Visit the Hospital 2-3 days in advance so that Hospital can send the Cashless request to your Insurance Company/TPA in advance and approval can be received before admission.
  • In case of emergency, get the Patient admitted in the Hospital. Check if the Hospital is in network list, if yes, visit the TPA/Billing desk.
  • The Hospital will send the Cashless request/Pre-authorization form to the respective Insurance Company/TPA for approval.
  • Once the request is approved by the TPA/Insurance company, the cashless department will process the request as per policy terms and condition and send an Authorization letter to the Hospital.
  • Initial Authorization will be less as compared to the requested amount as the final Authorization will be sent at the time of Discharge when the Hospital will provide the final Bill and Discharge Summary.

At time of discharge collect Photo copies of all the below mentioned Documents for your future reference:

  • Discharge card
  • Hospital Bill
  • Investigation reports
  • Indoor cases Papers
  • Collect all the Original paid receipts in case you have made the Payment

Best of Luck on the purchase of your Mediclaim Policy!