Cashless Hospitalization – What You Should Know

Cashless Hospitalization

Cashless hospitalization is a facility provided by the insurance company where the policyholder can get admitted and undergo necessary treatment without paying the hospital directly for the medical expenses. The eligible medical expenditure which is incurred is settled by the insurance company directly with the hospital. You can avail cashless hospitalization only in the hospitals that are part of your TPA’s network. Medi Assist enables you to avail cashless hospitalization at a hospital that falls within your insurer’s network and also entitles you to discounts and reduced package tariffs at these hospitals. Hospitalization and related expenses can be made cashless upon approval of pre-authorization based on your policy cover. It allows you the relief of no upfront payments from your pocket.

At Medi Assist, you can avail cashless and eCashless hospitalization at our network of hospitals.

Cashless Hospitalization Procedure

Emergency hospitalization:

  • Visit medibuddy.in/ecardto view and download your e-Card instantly.
  • Visit medibuddy.in/networkHospitals for a GPS map based search to locate nearest network hospital.
  • At the hospital, display your e-Card at the insurance desk.
  • Complete and submit the pre-authorization form.
  • Your Hospital will send the form to Medi Assist for approval.
  • During the course of hospitalization, Medi Assist may request your hospital for additional information to approve interim claims and final bills before discharge.
  • Track your claim in real time- Medibuddy:
    – Click the Claims tile
    – Visit www.medibuddy.in/claim

Do Note:

  • The hospital will ask you to pay for all the non-medical expenses in your bill.
  • You will have to pay for all pre- and post-hospitalization expenses. These can be claimed only after the settlement of the main hospitalization claim.
  • At the time of discharge, check and sign the original bills and the discharge summary. Do carry home a copy of the signed bill, discharge summary and all your investigation reports for future reference.

 

Planned Hospitalization

eCashless:

  1. Visit www.medibuddy.in/ecard to view and download your eCard instantly.
  2. Click the eCashless tile on your MediBuddy mobile app or Click the Hospitalization tab on the portal.
  3. Enter the details of your impending hospitalization and send your intimation at least 48 hours ahead of admission.
  4. You receive a secure passcode confirming your provisional preauthorization.
  5. On the day of admission, you present your secure passcode, e-Card and photo ID card at the hospital.
  6. Submit additional information as required to process interim claims and final bill before discharge.
  7. Track your claim in real-time-MediBuddy

Note: In case of suppression of material facts or misrepresentation of facts by the hospital or the insured, the pre authorization issued for the cashless facility will stand cancelled. The insured will be liable to settle the hospital bill in full.

Hospitalization, Claims and Expenses

Hospitalization, Claims and Expenses: Things You Should Know

Hospitalization, Claims and ExpensesAs humans, we are bound to fall sick and get treated. We may even get hospitalized at some point of time. As a person who may be covered under a health insurance policy and opting for hospitalization, these are some basic things you should know about hospitalization, claims, and expenses. Read on to know some of the basics of hospitalization.

Hospitalization

Hospitalization can be of two types:

  • Planned hospitalization
  • Emergency hospitalization.

Planned hospitalization happens when you have ample time to plan your admission to the hospital. For example, if your doctor advises a surgery for hernia anytime within a couple of weeks, you have time to plan your hospitalization. Emergency hospitalization happens typically in case of emergencies such as domestic accident or a road accident. One cannot plan such a hospitalization.

Benefits of planned hospitalization

If you are aware of the fact that you or your family members require hospitalization in the near future, you can send prior intimation to Medi Assist to plan your hospitalization. Not only does this ease the admission and pre-authorization process, but it also helps reduce your overall cost of treatment wherever possible.

Once Medi Assist receives the intimation, we will help you plan everything including choosing a network hospital, opting for discounted packages, if available, and planning for cashless hospitalization. Here are the advantages of a planned hospitalization:

• You get a green-channel hospitalization which means that the hospital is aware of your impending admission and your wait        time on the date of admission is significantly lesser.
• The Medi Assist executive helps you compare tariffs and facilities at various network hospitals so you can make an informed      choice.
• You have the benefit of opting for discounted packages, negotiated by Medi Assist exclusively for our members, along with          the benefit of cashless admission, wherever applicable.
• Even if your policy places a cap on your hospitalization expenses you can reduce your out-of-pocket expenses by choosing the discounted price available to you as a Medi Assist member.

Hospitalization expenses

Expenses associated with hospitalization can be classified as follows:

Pre-hospitalization expenses: When you’re unwell, you will most likely consult a physician first, who gets relevant investigations done before advising hospitalization. Such medical expenses incurred before hospitalization are called pre-hospitalization expenses.
Hospitalization expenses: All expenses incurred as part of your hospital stay as an in-patient can be termed as hospitalization expenses.
Post-hospitalization expenses: Some part of your treatment may extend beyond your hospitalization. It may involve follow-up visits to the doctor, prescription medication, further investigations, etc. Such medical expenses are called post-hospitalization expenses.
Domiciliary hospitalization expenses: This typically includes expenses related to domiciliary hospitalization – at-home medical treatment for more than three days for cases which in the normal course would require hospitalization. The exact circumstances / terms / exclusions related to domiciliary hospitalization would be spelled out in your policy document.

Apart from hospitalization expenses, your health insurance policy may also cover pre- and post-hospitalization expenses, and offer a cap for domiciliary expenses.

Medical Insurance Claims Processing

Depending on the situation and your policy coverage, you can make two types of health insurance claims:

Cashless: The essence of cashless hospitalization is that the insured need not make an upfront payment to the hospital at the time of admission. You may not have any out-of-pocket expenses towards hospitalization in this scenario. Cashless hospitalization can be availed only at a Medi Assist network hospital and upon approval of your pre-authorization application.
Reimbursement: A reimbursement claim is one where you pay all the expenses related to the hospitalization of the insured and claim a reimbursement of your expenses after discharge. Reimbursement claims may be filed in the following circumstances:
– Hospitalization at a non-network hospital
– Post-hospitalization and pre-hospitalization expenses
– Denial of pre-authorization for cashless facility at a network hospital.

Visit MediBuddy for the updated list of network hospitals. You can also find more information on the MediBuddy eCashless feature, cashless hospitalization and claims management.

Your Third Party Administrator: What You Should Know

Third Party Administrator

If you are covered by a health insurance policy, you will be allocated a third party administrator or TPA by your insurance company. However, most people are unaware of who a TPA is or what a TPA does. Here is what you should know about the third party administrator:

• If you are reading this, this means that you have probably been assigned Medi Assist as your TPA for health insurance benefits managed by your organization. As a member of Medi Assist family, you are eligible for hassle-free healthcare insurance claims administration.

• What this really means for you is that, if you or any of your family member is covered under the insurance policy, we handle all the paperwork related to your claims. Wherever possible, we give you the benefit of cashless hospitalization; and we ensure that your claim is settled at the earliest.

• As a member of Medi Assist, you are not only entitled to hassle-free claims, but also several other health benefits.

• However, you should understand that TPAs are not the same as insurance companies.

What does a third party administrator (TPA) do?

A TPA is appointed by your insurance company to process your claims. This means that whenever you raise a claim for hospitalization for yourself or any of your family members covered under the policy, a TPA processes these claims.

What a TPA does not do:

• Decide who is covered and what ailments/procedures are covered under your policy. Your insurance plan dictates these.

• Control your policy terms and conditions. Your insurance policy is developed by your insurance company.

• Decide admissible/non-admissible expenses. Your insurance policy dictates that.

• Approve/disapprove claim without reason. TPAs process claims strictly based on your policy terms and conditions.