How does Cashless Hospitalization work?

Answer 1

Let us take an example situation and try to figure out how it works. Let's say our Uncle Sam has suffered a Heart Attack and needs a Surgery to be done within the next 2 or 3 days. Luckily Uncle Sam has a medical insurance policy and his son is planning to use the cashless hospitalization facility to treat his father. This is how it will happen

Step 1: Uncle Sam's son contacts the Hospital Reception, explains the situation and inquires about the cashless hospitalization facility.

Step 2: The Receptionist gives him a form to fill-up to request Cashless Hospitalization

Step 3: Uncle Sam's son fills up the form, signs it and hands it over to the Receptionist

Step 4: The Hospital sends out the details to the Insurance company

Step 5: Officers at the Insurance company validate the documents and the details of the insurance policy. They check if Uncle Sam has enough coverage to pay for the hospitalization. Once they validate they send out a response to the Hospital.

A point to note here is that, the company would send out details of the amount they would pay for the treatment, and the kind of expenses they wouldn't pay. For Ex: They can say that, Uncle Sams policy covers upto Rs. 2 lacs of treatment and we will not pay for Air Conditioned rooms and food expenses. The rest of the treatment upto Rs. 2 lacs is covered.

Step 6: The Hospital receives the communication from the insurer and shares the news with Uncle Sam's son.

Step 7: They ask him to sign an agreement that, whatever expenses are not covered would be paid by him before Uncle Sam is discharged

Step 8: After he signs the agreement, the hospital will begin Uncle Sam's treatment

Step 9: Uncle Sams treatment is over and he is getting discharged today. His son is going to pay the balance amount due to the hospital and take his healthy dad home...