Do all health insurance policies offer cashless hospitalization facility?

No, not every healthcare Insurance policy offers cashless hospitalization. Your policy is routed through a third party administrator. Network hospitals may be defined as those hospitals which allow for cashless hospitalization based on certain conditions. When you are admitted in a non network hospital you will need to submit your bills to the hospital and seek reimbursement through TPA.

Does cashless hospitalization mean I can just walk into a hospital and get admitted for treatment free of cost?

Cashless treatment is misunderstood as free treatment. This is not the case as the insurance company will bear the cost of the treatment depending on the medical treatment which has been given. Mediators ensure that cashless hospitalization is performed quickly and easily and ensures that all bills are submitted and paid by the insurance company on time. There are very strict protocols which need to be followed which are laid down by the IRDA(Insurance Regulatory and development authority)

What procedures should I follow to avail the facility of cashless hospitalization at Vijaya Health Care?

Planned Admission

In case of a planned admission, you can avail of various types of facilities which are planned and executed well in advance. Planned admissions must be fixed with your TPA well in advance with a minimum buffer of 4-5 days and this ensures that every aspect of the insurance claim is processed completly and perfectly. We request you to achieve pre-authorization for your insurance claims and contact our reception desk. While we process the TPA claims and forward them to the third party insurers, we cannot gaurentee that the claim will be processed perfectly.

The pre-authorization procedure is detailed below:

• Contact a network hospital.
• Present the cashless insurance card
• Submit the pre-authorization forms which are required by the TPA
• Every pre authorization section is divided into two halfs these contain the general details on the health insurance policy and the treatment which is suggested by the duty doctor and this must be only filled by the medical practioner.
• Once the TPA form is filled, we will arrange to send it and fax it to the specified third party assurer.
• We will revert back to you with the approval or denial status

Emergency Hospitalization:

In case of emergency hospitalization, the Reception will take up your case on a fast track basis with your TPA and is likely to receive approvals within 6 hours during any working day. For cashless treatment it is mandatory for the hospital to have an approval from your TPA. In case of delay in receiving the approval or when you cannot wait for receiving the approval owing to medical urgency you can undergo the treatment by paying the necessary cash deposit. If you receive approval from your TPA, you are entitled for refund of the cash deposit.