Cashless Treatment in Non-Network Hospitals: How New Rules Allow Treatment Without Advance Payment

How Policyholders Can Access Cashless Treatment in Non-Network Hospitals

Recent changes in health insurance regulations have expanded access to cashless treatment. Policyholders can now receive medical care in non-network hospitals without making advance payments. Let’s explore how health insurance holders can benefit from this update and get cashless treatment in any hospital.

1. Understand Your Policy

First, ensure that your health insurance policy has been updated with the new provisions. Some policies may need adjustments or upgrades to offer cashless treatment in non-network hospitals. It’s also important to know the coverage limits and exclusions specific to your plan.

2. Pre-Approval Process

While cashless treatment is now available in non-network hospitals, pre-authorization is essential. Before or shortly after being admitted, either you or the hospital must inform the insurance company, which will review the treatment plan and estimated costs for approval.

3. Steps for Pre-Authorization

You will need to submit your health insurance card, a valid ID, medical reports, and the estimated cost of treatment to the insurance company. Wait for their approval, which typically takes under an hour.

4. Keep Documents Ready

To ensure a smooth claims process, prepare these documents: your health insurance card or policy details, a valid ID proof (Aadhaar card, PAN card, etc.), medical reports, doctor’s notes including prescriptions, and test results. The hospital’s treatment assessment should also be included.

5. In Case of Emergencies

Some insurance companies allow post-treatment authorization for emergency cases. This means you can receive urgent care and seek approval afterward. You must notify the insurance company within 24 hours of hospitalization to avail this benefit.

6. Seek Help from the Hospital TPA Desk

Most hospitals have a Third-Party Administrator (TPA) desk that acts as a mediator between you, the hospital, and the insurance company. The TPA desk provides free service to help you claim expenses based on your policy and guides you on any out-of-pocket costs you may need to cover.

By understanding these key steps, you can access seamless cashless treatment in both network and non-network hospitals, ensuring you receive timely medical care without financial worries.