September, 2018

Medical Insurance

Cashless Mediclaim


Cashless Hospitalisation – How Does it Really Work?

Cashless mediclaim insurance facility is a great benefit offered by insurance companies and corporates both for their consumers/employees as an option of getting trouble-free hospitalisation where payments are done directly by the insurance company without the hassle of paperwork and carrying cash with you. One usually enters a hospital only in case of emergency or for corrective measures and ‘Cashless’ hospitalisation was a boon in disguise for the common man. But years of abuse by the doctor-hospital-diagnostic centre nexus, which was supposed to be a truly hassle-free experience has now become a little complicated.

When my father-in-law got admitted to Lilavati Hospital for his heart surgery 14 years back, he just presented his cashless mediclaim insurance card and all of us just breezed through the admission process. Today when I came to the same hospital to admit my wife for her knee surgery, I realised that the process had become a bit complicated only because of the amount of paperwork that now needs to be submitted beforehand. Thank god that I came a day before the surgery to understand the process and settle all documentation if I would have taken the word “Cashless” literally I might have suffered a bit. Do read on to understand what actually needs to be followed in case you need to avail the cashless facility so that god forbid if you ever need to avail this, you know exactly what to do. In the case of a planned surgery, it is best to go to the hospital at least 2 days before to get all the documentation sorted and the approvals are done. Here goes a step by step account of the process to be followed: (Please carry your insurance card provided by your organisation and your employee id card with you)

  1. Every hospital has a TPA/Corporate Desk. It is a small room and will be in the reception itself with ‘TPA/Corporate’ written on it with bold letters. They will give you a TPA form to fill. This form has two components as follows:
    • Patient Details – can be entirely filled by yourself
    • Diagnosis and Surgery Details – These can only be filled by your doctor/surgeon operating on you. Factor in your doctor’s availability and time to get this filled. These details will also determine the grade of the surgery and hence the estimated cost.
  2. You will need to carry with you and submit all reports (doctor’s/surgeon’s) and the CT scans/MRIs/Xrays et all. Which prove that surgery, and hence hospitalisation, is required for the concerned patient.
  3. Pan Card and Aadhar Card – These are MANDATORY to be submitted. Please carry both for the patient and for yourself (in case you are the insured and the patient is your spouse or parent).
  4. Also keep your bank account details handy so that if there is any petty amount that needs to be transferred to your account, the hospital can do it. You will also need to carry a cancelled blank cheque with you. There is a separate form that needs to be filled for this and if you don’t have this information handy it will be a pain to get all of this at the last minute.
  5. If you have any other medical insurance, besides the one under which you are claiming ‘cashless’ for, you will need to submit details of that too. So keep your policy number and insurance company name handy to put down on the form.
  6. Room Type and Rate – Most cashless mediclaim insurance products have a limit on the per day room rate & hence the category. Check beforehand with your HR on whats your eligibility and limit. Please try to stick to within that as much as possible. CAUTION – Just in case you want to upgrade, please remember that with the change in grade to a higher one, every other cost of hospitalisation changes exponentially. The final cost total may turn out to be at least 60-70% if you select a higher category room and the insurance company will not cover the difference.
  7. Once you have submitted the TPA form duly filled along with at least 3-4 other forms capturing all information mentioned in the points above, you need to call up your HR and speak to the concerned executive in charge of this for your organisation. He/she can then speak to the insurance company representative/desk and will get your approval done immediately. (Mine took exactly 45 minutes for it to come through).
  8. Only when you get the approval on email, is when you are truly ready for a ‘Cashless’ experience. But do remember every hospital will need for you to pay a certain amount to start with and this could be anywhere between ₹10,000-15,000. In my case, it was ₹10,000 (5000 for OT booking & 5000 for admission…this hopefully gets refunded back to you).
  9. Like I mentioned at the start, I will reiterate again. Go to the hospital at least a day in advance and get the ‘Cashless’ process sorted so that on the actual day of admission, you can be a bit relaxed.

I hope this blogpost is beneficial to you and do share this across your networks so that people will know and will be spared the hassle of paperwork during the hospitalisation process.