{"id":32641,"date":"2021-07-07T11:48:51","date_gmt":"2021-07-07T06:18:51","guid":{"rendered":"https:\/\/corpbiz.io\/learning\/?p=32641"},"modified":"2021-07-07T11:49:20","modified_gmt":"2021-07-07T06:19:20","slug":"when-hospital-refuses-to-facilitate-cashless-treatment","status":"publish","type":"post","link":"https:\/\/corpbiz.io\/learning\/when-hospital-refuses-to-facilitate-cashless-treatment\/","title":{"rendered":"What to do when Hospital refuses to Facilitate Cashless Treatment?"},"content":{"rendered":"\n

Having a bevy of insurances at the disposal is\na boon to a person who belongs to the lower or medium strata of the society. They\nnot only provide complete protection but also eradicate the risk of being penny\nless in the most demanding situation. People nowadays are keener to route some\nof their earning towards insurance products. At present, almost every medium-class\nfamily prefers buying medical policies owing to the ever-rising expenses of\nmedical treatments. These policies are meant to give pre-determined coverage\nfor medical expenses with other benefits like cashless treatment, and tax\nexemption on premium paid on them.  For\nthe most part, the insurer doesn\u2019t deviate from what they claim under the\npolicy.  But it seems that things are not\ngoing as expected in the present scenario, as thousand of insured are\nconfronting trouble in availing cashless treatment in hospital, especially in\nthe treatment of Covid-19 virus. <\/p>\n\n\n\n

Cashless treatment is one of the major selling\npoints of the majority of medical policies. But in the past few months, it has\nbeen noticed that the majority of the insurer were failing to render this\nfacility to the needy ones. If you are confronting the same problem, then there\nis a way out. <\/p>\n\n\n\n

How Insurer\nfacilitates Cashless treatment under a Medical Policy? <\/h2>\n\n\n\n

First, an insured visit to the empaneled hospital, get a cure for a disease covered under the policy and then seek a cashless treatment facility by providing details of the policy to the hospital. <\/p>\n\n\n\n

Once the insured gets discharged\nfrom the hospital, all the medical bills are routed to the insurance provider.\nThe insurance provider, in response, computes the expenses and settles the\npayment. <\/p>\n\n\n\n

The claim regarding cashless treatment varies in accordance with the type of treatment-planned or unplanned. Unplanned medical treatment usually comes into existence in a state of emergency. <\/p>\n\n\n\n

Read our article<\/b>:How to Establish Insurance Brokerage Company in India? <\/a><\/mark><\/p>\n\n\n\n

The process regarding the planned\ntreatment at the cashless network<\/h3>\n\n\n\n

Typically, the insured has to intimate the insurer regarding the treatment required before claiming the cashless treatment. The company ought to be intimated at least 4 days before the treatment begins. The insured must submit the cashless claim request at the relevant address of the insurer via, fax, email, or post.<\/p>\n\n\n\n

For more clarification, you can\nget in touch with the customer care of the insurer company. Once you meet these\nrequisites, the insurer will communicate with the insured as well as the\nconcerned hospital regarding the eligibility and policy cover.  On the day of visiting the hospital, the\ninsured has to facilitate the confirmation letter along with a health insurance\ncard. The insurance provider will finally reconcile the medical expenses, by\nmaking payment to the concerned hospital.<\/p>\n\n\n\n

Claims Process regarding the Emergency Treatment at the Cashless Network<\/h3>\n\n\n\n

The policyholder can get in\ntouch with the insurance provider via customer care number to avail detail\nregarding the nearest network hospital. \nBy sharing your policy details, you can avail cashless treatment. After\nregistering the claim request, the hospital forwards the cashless claim request\nform to the insurer via post, e-mail, or fax. <\/p>\n\n\n\n

In response, the insurance\nprovider will issue an authorization letter to the hospital, reflecting the\nterms of policy coverage. The insurer will make the payment regarding medical\nbills on the behalf of the insured to the hospital. In case of claim denial,\nthe insurer will communicate with an insured via a letter, reflecting the\nreasons for the same. <\/p>\n\n\n\n

Process of enrolling complaint regarding Cashless Transaction <\/h2>\n\n\n\n
\"Process<\/figure><\/div>\n\n\n\n

Legally,\nyou are allowed to lodge a grievance against the hospital in case they deny rendering\ncashless treatment. But, it is advised that you must figure the solution with the\nThird-Party Administrator (TPA) for prompt reconciliation before taking such an\naction. <\/p>\n\n\n\n

But, if the thing doesn\u2019t work out with TPA, then go ahead and follow the process below. <\/strong><\/em><\/p>\n\n\n\n