Hospital is Empanelled with the Insurer for Cashless Claims

If you invest in a healthcare policy today, then you end up securing your future expenditures on healthcare needs. A health plan not only covers your loved ones from uncertain and unfortunate health events but also protects your long-term savings. Most of the health policies provide the facility of getting treatment all over the world with the benefits of cashless treatment in empanelled hospitals. This blog will provide you with relevant information regarding empanelled hospitals and cashless facilities you can avail through an insurance plan.

 

Empanelled Hospitals

Empanelled hospitals are the ones that fulfil the minimum prescribed standards and are tied up with an insurer as a network hospital. Every health insurer has an agreement with major hospitals to provide cashless treatment to its policyholders. The policy document of healthcare insurance has a list of network hospitals where you can get cashless treatment. According to the policy, the medical insurance company provides cover for hospital fees and expenses incurred before and after hospitalisation.

 

Network and Non-Network Hospitals

In case you decide to choose a network hospital for treatment, you just need to present the health card issued by the insurer to avail of the cashless medical insurance benefits. Non-network hospitals are not registered with the insurer, and you can not claim cashless treatment at these hospitals. If you are a policyholder and you want to get treatment at these hospitals, you have an option of reimbursement. Post-discharge, you need to submit the required documents, which involve documentation and paperwork. After approval, the patient will receive the refunded amount.

 

Cashless Claims at Network Hospital

Cashless medical insurance helps you sail through tough times and unfortunate events. It protects your saving and provides a stress-free environment for medical expenses. Here are the steps which help you to avail of the benefit:

 

Planned Hospitalisation

• Find the best and nearest network hospital from the list.
• Download the pre-authorisation from the Third Party Administrator.
• Fill up the form and then submit it to the insurer of the selected network hospital.
• You will receive approval along with the coverage details.
• Present your health policy card issued by the insurer on the day of hospitalisation.
• Submit your authorisation form within the time period of validity.

 

Emergency Treatment

• Fill out and submit the pre-authorisation form within 24 hours of hospitalisation.
• The insurer is likely to approve your claim within a few hours.
• You can either wait for Third Party Administrator approval or can pay bills at that moment itself and then apply for reimbursement.

 

Documents Required to File Claims

There are various documents required to make claims. Some of the significant documents which are needed at the time of claim settlement are as follows:

 

• Health card
• Valid ID proofs
• Bills and receipts
• Claim form
• Test reports
• Copy of an FIR in case of accidents.

 

Day-Care Facilities Provided at Network Hospitals

Daycare facilities are covered under most of the insurance plans by network hospitals. Here are some facilities you can avail at network hospitals:

 

• Eyes: Cataract surgery, Corrective surgery, Tear duct surgeries, etc.
• ENT: Septoplasty, Tympanoplasty, Foreign body removal, etc.
• Tongue: Incision, Excision, Glossectomy, etc.
• Cancer Treatment: Chemotherapy and Radiotherapy
• Heart: Coronary Angiography
• Other surgeries

 

Exclusion of Services under Network Hospitals

There are some exclusions of services which you must keep in mind if you are a policyholder.

 

• Hospitalisation due to self-harm or suicide.
•  Hospitalisation in case of war or biological weapon.
•  Hospitalisation due to alcohol abuse.
• Additional expenses like special diets.
• Treatment of diseases like HIV AIDS, unless specified in the insurance policy.

 

How to Check if a Hospital is Empanelled with the Insurer for Cashless Claims?

After knowing various benefits, inclusions and exclusions of network hospitals, you must be wondering how to check if the hospital is empanelled with the insurer or not. It is a simple process wherein you need to check the policy document, which provides the list of hospitals considered network hospitals. The other way is to check the list of empanelled hospitals on the insurance company’s website. Most of the insurance companies upload a list of network hospitals for policyholders from where you can make a choice. If the hospital you are planning for treatment is there in the list, then you can get cashless medical treatment.

 

Having health plan coverage keeps you on the safer side in medical emergencies. It has protected many families by providing financial support and cashless medical insurance in the best hospitals. Niva Bupa is among the leaders in providing cashless health insurance plans for family with high customer satisfaction along with a high claim settlement ratio. One must consider the services a health insurer provides before making a final purchase decision.