CASHLESS HEALTH CLAIM PROCESS: WHAT TO DO
The first 72 hours, from Claims Desk by RFS

Almost every cashless claim that goes wrong goes wrong at the desk, in
the hours around admission and the minutes around discharge.

WHAT LOSES IT
Hearing 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.

1. Check the hospital is on the insurer's own network  [Before admission]
   Cashless 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.

2. For a planned admission, get the pre-authorisation before you go in
   [Before admission]
   The 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.

3. For an emergency, tell them from the hospital  [Same day]
   Admission 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.

4. Read the approval letter, not the number people say aloud
   [At admission]
   The 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.

5. Take the room the policy allows  [At admission]
   Room 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.

6. Keep every original, and every sticker  [Throughout]
   Discharge 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.

7. Answer the queries the day they arrive  [Throughout]
   The 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.

8. Do not take discharge until the final authorisation is in writing
   [At discharge]
   The 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.

------------------------------------------------------------------------
Claims Desk by RFS - claimsdesk.in - 92514 56334
We run insurance claims end to end, including on policies placed
elsewhere. Nothing here is legal advice, and what your policy pays
is decided by its wording and the facts of the loss. Where this
says 'the time your policy sets', read your own wording: the
periods genuinely differ and a wrong one costs the claim.