The financial predicaments of the middle class usually revolve around the medical expenses. While ailments are the quickest to surface, getting the desired treatment at high-end nursing homes and clinics often becomes impossible courtesy of the lack of reliable and rewarding health insurance facilities. Therefore, having a cashless Mediclaim policy for family is probably the easiest step towards a state of financial and physical well-being. However, before purchasing the best cashless Mediclaim policy for the family from concerned vendors, it is important to analyze a few points and even look at the existing loopholes, if any. The insured must take a note of the associated factors for evading unwanted situations emanating out of cashless Mediclaim policies, in due course of time.
The Reality of a Cashless Arrangement
In order to avail the benefits of cashless claim, the insured must raise a request to the concerned insurer via the associated TPA. It is the TPA who has the rights to accept or reject a claim, depending on the existing conditions, choice of hospitals, and a host of other factors. If things go according to plan, the TPA approves the claim and the concerned insurance company offers coverage for an amount comparable to the overall sum assured. That said, there is an empaneled network of medical facilities synonymous to the insurance company and the insured is entitled to benefits only at these hospitals.
What are the Essential Steps?
For a planned treatment, the insured must inform the TPA at least 2 days in advance, before getting admitted. However, if there is an emergency and the person need to be admitted immediately, informing the TPA within a timeframe of 24 hours is a still a good option. Moreover, it is important to inform the hospital authorities as well, regarding the mode of payment and the Cashless Mediclaim policy for family, before entering the premise.
It is important to keep the insurance card handy throughout the process, in order to provide details at every juncture. An insurance card synonymous to the insured contains details regarding the existing policy, policy number, and name of the insurer.
When it comes to putting the claim forward, the insured must duly fill up the pre-authorization form and send it over to the TPA. The concerned TPA moves the application forward on the basis of furnished details; thereby arranging for cashless coverage.
Are there any Loopholes?
The insured must be extra careful while filling up the application form. It is also important to note that the TPA has the authority to reject the claims on the basis of certain factors. Firstly, while purchasing the insurance, the insured must carefully look at the ailments which are covered under the plan as anything else wouldn’t be covered for. Moreover, making correct declarations when it comes to filling up the application form is also important as furnishing incomplete details invariably rejects the insurance claims. Other factors which can interfere with the coverage include faulty documentation process and exhaustion of the assured limit.
Cashless Mediclaim has simplified the availability of high-end medical treatments and other facilities. However, in most cases, the insured still needs to pay for diet changes, oxygen masks, nebulizers, and other add-ons. The best advice would, therefore, be only to raise the amount that is acceptable by the insurance company, in order to avoid unnecessary hassles, while putting across the claim.