How to go for cashless hospitalization?

My experiences with GMIS Policy.

by Rajeev Pathak

In my previous post, I had written about Adequate health insurance at an affordable cost for bank retirees is the need of the hour. Most of the people more particularly retirees have purchased one or another health insurance policy. The Health Insurance Policy is also popularly known as Mediclaim policy. A cashless hospitalization facility is one of the important features of any health insurance policy. But most of the people hesitate to avail this facility. The purpose of this post is to make you aware of How to go for cashless hospitalization?

Recently, I had to undergo hospitalization. So I am sharing this procedure on the basis of my own experience with the cashless hospitalization facility. I hope after going through this post, one will have a better idea about How to go for cashless hospitalization?

On 19^th Sep 2021, I was admitted to Apollo International Hospital, Gandhinagar (Gujarat) as my blood platelets were gone down to 10,000 due to Dengue against the minimum requirement of 1,50,000. As a member of IBA-sponsored GMIS-NICL-BOI-policy, I availed cashless hospitalization facility. My experiences with the facility, with HITPA, the TPA, and with the hospital were excellent. 

I list down the stepwise requirement for a hassle-free cashless treatment under our GMIS policy.

Documents to carry:

One has to carry the following documents while going for hospitalization:

·       E’card issued by the TPA

·       Photo ID card: I had carried my PAN Card and also my Aadhar card. As now PAN card is linked to the Aadhar card, they ask for Aadharcard.

·       A Credit Card/cheque for initial deposit: I carried my India card.

·       Bank A/c details: Our bank account details will be needed on the day of discharge for the refund of the deposit, if any.

Procedure at the hospital/TPA Desk:

I am pleased to share that my treatment was started within a few minutes in the Emergency ward after reaching the Hospital. For this, I am thankful to Senior Physician Dr. Jay Kothari, his team, and the hospital administration. 

Photo by Karolina Grabowska from Pexels

The hospital issues an application form that is to be filled in for cashless treatment. The form needs the signatures of the treating doctor. One has to give this form at the TPA Desk which is generally set up at big hospitals. For this work, one needs the help of someone from his family/friends. I wish that this procedure could be coordinated online by hospital administration and the TPA, reducing the need for physical movement.

The hospital obtained an initial deposit of Rs.10,000 that I paid through the India card.

The TPA forwards the cashless application online to his office. Within the next half, an hour or so, approval for a certain amount is accorded. In my case, the approval came the next morning maybe because the 19^th was a Sunday, and the form was sent a little late in the evening.

Amount of initial approval:

The initial approval amount is fixed based on standard expenses involved in the treatment of a particular disease. In my case approval for expenses up to Rs.30,000 was received. The approved amount was conveyed to me by SMS/email.

No need to worry in a hurry:

This is an important stage. Someone may think that the insurance company/TPA has approved only this little amount, so they convert their option from cashless to Cash Payment in a hurry. They pay in full, collect the documents from the hospital, and then submit their claim to the company. In my view, this is not required. Giving the prior approval of a token amount is the normal practice adopted by TPAs.

On the Day of Discharge:

On the day of my discharge on 24^th Sep’21, the hospital submitted my bill for Rs.76,311 to the TPA. I was also informed by the hospital by SMS/email. Within few minutes the TPA Desk uploaded the claim and forwarded it to their office. In the next few minutes, I got the SMS/email from the TPA office that a claim for Rs.76,311 is approved. The hospital also communicated the same to me. 

Accordingly, I walked out after my discharge from the hospital.

The one good thing, I observed is that I was informed about the movement of my claim by SMS/email by all three ie; the hospital, the TPA Desk, and also the TPA office.

Verification call from TPA office:

On 26^th September, I received a phone call from TPA’s Delhi office verifying the following 5 (five) facts:

·       What ailment I had,

·       Who was the treating doctor,

·       What was my room number,

·       the bill amount, and

·       the date of discharge.

On 27^th September2021, Rs.10,000/ deposit made by me at the hospital was refunded and credited to my bank account.

Conclusion:

I have shared my own experiences and on that basis written this post,  How to go for cashless hospitalization? The experiences of people may vary from hospital to hospital and also from TPA to TPA. But, I am of the view that cashless hospitalization is convenient. The facility makes us free from unnecessary worries of arranging for money at the time of the discharge.

If you find this post useful, please shares it with others who may be in need of such information. You may also post your feedback/suggestions in the Comment Box. 

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