Cashless is a payment arrangement, not the claim itself.
Almost every cashless claim that goes wrong goes wrong at the desk, in the hours around admission and the minutes around discharge.
What loses itHearing no at the hospital desk and treating it as the insurer's answer. A refused pre-authorisation is a refusal to pay the hospital directly. The claim itself is untouched, and is still made by paying and claiming it back.
- Check the hospital is on the insurer's own networkCashless only works at a hospital the insurer has an agreement with, and the lists differ between insurers and change. Check on the insurer's or the TPA's site, by name and by city, before you choose where to go. Anywhere else is a reimbursement claim, which is still a claim.Before admission
- For a planned admission, get the pre-authorisation before you go inThe hospital's insurance desk fills the pre-authorisation form and the treating doctor signs it. Send it in the time your policy sets, which is days rather than hours for planned treatment, and take the approval letter with you. Do not travel on an assurance given on the phone.Before admission
- For an emergency, tell them from the hospitalAdmission comes first. But the intimation has to go within the hours the policy allows, and that clock starts at admission, not at discharge. A call to the number on the health card, followed by the hospital desk filing the form, is enough to start it.Same day
- Read the approval letter, not the number people say aloudThe first authorisation is usually for less than the bill will be, and it is a working figure. Check what it covers, what it excludes and what it says about the room category. Ask the desk for a copy for your own file, because it is the document the rest of the claim argues with.At admission
- Take the room the policy allowsRoom eligibility is written into the schedule as a category or a limit, and a room above it is the commonest reason a health bill comes back cut. If the hospital moves you up for availability, get that reason recorded in writing on the file the same day.At admission
- Keep every original, and every stickerDischarge summary, the itemised bill, every investigation report, the pharmacy bills, and the barcode stickers and invoice for any implant or stent. Photograph each one as it is handed to you. Originals given to the hospital are gone, so photograph before you part with them.Throughout
- Answer the queries the day they arriveThe insurer or the TPA will raise queries during the stay and an enhancement request will usually be needed as the bill grows. Both are answered by the hospital desk, and both stall there. Ask each morning what is outstanding and who it is with.Throughout
- Do not take discharge until the final authorisation is in writingThe last hour is where cashless claims collapse: the ward wants the bed, the final approval has not come, and somebody is asked to settle it themselves. Wait for the written final authorisation, and if you do pay, pay against the itemised bill and keep every original for the reimbursement claim.At discharge
The quiet oneUnderinsurance. If the sum insured is below the value actually at risk, the average clause reduces the claim in proportion however well the rest of it is run. Check where you stand. It takes three numbers and nothing is stored.
Employee Injury Claim
An employee, contractor or site worker injured or killed at work.
Liability Claim
A third party alleges injury, damage or loss caused by you or your product.
Take this with you as a text file. It opens with no signal, prints on one page, and forwards to whoever is actually standing at the loss.
Standing at the billing counter with an approval that has not come?
Whoever placed your policy, and whatever stage the claim has reached.
Three deadlines
- Tell the insurer now, not after the assessment.
- Notice to anybody else responsible the carrier, the contractor, the police, within the time your policy sets.
- Every document within the time the insurer asks for it.