Mengenai Hospital

• Health insurance is a financial cover that helps manage medical expenses as per your policy terms, coverage limits, and exclusions.  
• It typically includes hospitalization, procedures, and investigations, depending on your plan.  
• All approvals and claim decisions are made by your insurance company or Third-Party Administrator (TPA), based on the policy conditions.

Health insurance can be used in two ways: cashless and reimbursement.  

• In cashless treatment, the insurance company directly settles the approved medical expenses with the hospital, reducing the need for upfront payments.  
• In reimbursement, you pay the hospital bill at discharge and later submit the claim to the insurer for repayment as per policy eligibility.
• Cashless treatment is available only at hospitals that are part of your insurer or TPA network. If you choose a non-network hospital, you can still avail treatment but will need to proceed through the reimbursement route. It is always advisable to check hospital network eligibility with your insurer before admission. 

Pre-authorization is a mandatory step for cashless treatment, where the insurer reviews and approves the estimated treatment cost. The approach differs based on whether it is a planned hospitalization or an emergency.

• For planned hospitalization, this process should ideally be initiated with the insurer or TPA4 8–72 hours in advance.  
• In case of emergencies, the hospital will initiate the request immediately after admission to ensure timely processing.
• To facilitate this process, patients are required to submit a valid government-issued ID proof such as a PAN card, Driving Licence, or Voter ID. For corporate insurance policies, a copy of the employee ID card may also be required. 

• Once approved, the insurer settles eligible expenses directly with the hospital under cashless treatment.  
• However, certain items such as non-medical consumables, registration charges, and personal expenses are not covered and must be borne by you.  
• If the final bill amount exceeds the approved amount, an additional request (enhancement) may be raised with the insurer. If the enhancement is not approved, the remaining balance will need to be settled by you at the time of discharge.
• In case approval is not received before discharge, you will be required to bear the entire cost of treatment and may subsequently apply for reimbursement with the insurer

• While most requests are processed smoothly, cashless approval may not be granted under certain circumstances.
• The condition requiring hospitalization is not covered under the insurance policy, including pre-existing diseases within waiting periods or specific exclusions such as alcohol-related incidents.  
• The pre-authorization request does not have sufficient medical information, and required clarifications are not available despite follow-up.  
• The insured sum or coverage limit under the policy has already been exhausted.  
• Our insurance team will guide you through the process and assist in minimizing the chances of rejection wherever possible. 

• Our dedicated insurance desk assists patients at every step, from documentation and pre-authorization to final billing and discharge.  
• We work closely with insurers and TPAs to facilitate faster approvals and provide clarity on processes, helping ensure a seamless experience throughout your hospital journey.