What is cashless Claim?
When a patient is treated in a network hospital (definition above), ManipalCigna Health Insurance directly settles the bill with hospitals. This is dependant on the claim request being approved by the hospital beforehand. However, there will always be a few items that the insurer is not allowed to pay as per regulation. These will always have to be settled directly with the hospital.
What is Planned hospitalization?
In planned hospitalization the treatment is planned well in advance. The intimation of such hospitalization and authorization from us has to be taken minimum 3 days prior to the date of hospitalization. E.g. Cataract, Pace Maker Implantation, Total Knee Replacement, other planned surgeries / treatments etc.
What is Emergency hospitalization?
In Emergency Hospitalization the patient is admitted to the network hospital in an emergency situation, for e.g. severe abdominal pain, accident, heart attack etc. In such event, we should be intimated within 24 hours of admission to the hospital for cashless treatment.
How do we I avail cashless treatment for planned / emergency hospitalization?
Please find the detail process flow step by step as attached link (cashless infographics).
How does one obtain the Authorization letter?
The authorisation letter will be sent to your registered email id and also available with TPA desk of the hospital.
Can a request for authorization of cashless treatment be declined?
Yes, a request for authorization of cashless treatment may be declined due to following common reasons.
a) The treatment which insured is going for is not covered under scope of policy terms and condition.
b) Inadequate sum insured.
c) Inadequate /Misrepresentations/wrong information
d) Ailment or treatment being taken falls under waiting period or policy exclusion
This only means that cashless facility is declined by the insurer and does not mean that the patient cannot undergo the treatment at the hospital. The bill that the insured incurs can still be submitted for evaluation for a reimbursement claim, even if he or she is at a network hospital.
To see the process for Reimbursement Claim click here <link to reimbursement inforgraphic)