28-08-2017 03:34 PM
In case of cashless facility – If I pay the advance amount in the hospital will that amount get added in the claim total amount or the same is borne by me?
04-10-2017 02:11 PM
This is the common problem for all of us will face at the time of admission. Even if we have cashless card from any reputed insurance company or TPA still hospital will demand to pay and collect back after settlement, is it right?
Usually, there will be approx minimum of 10% non medical deductibles in health insurance but at the time of cashless approval insurance company or TPA will approve for the full amount.
Claimed amount Rs. 50,000
Approved amount Rs. 50,000
this will create a confusion at the time of settling claim to the hospital, yes ofcourse it's not a mistake from your end but why hospitals are doing this. Due to technical issue or various other reason TPA or insurance company will not settle claim on time to the hospital (so called TAT, turn around time) so they might not collect the difference amount from patient hence hospital will collect security deposit from you and after settlement they will deduct the difference amount deducted by the TPA and rest will be given to you. This is hospital philosophy.
Solution: This can be done at the time of preauthorisation stage itself but TPA or Insurance company has to take necessary steps.