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Insurance Department

Insurance Coordinators at MicroCare ENT super speciality international Hospital take care of all documentation work of patients of both cashless facility or reimbursement facility. Patients have not been worried about any documentation hassles or any delays in documentation. Our specially trained Insurance Coordinators provides administrative assistance to all of your health insurance plans and provide you easy guide to avail cashless Hospitalization.

Is cashless hospitalization facility offered by all Health Insurance Policies?

Most Health Insurance policies offer cashless hospitalization facility. Usually they route your policy through a Third party Administrator (TPA).

Network Hospitals are those which are having tie up with your TPA.If you get admitted in a Network Hospital you will be eligible for cashless hospitalization facility subject to terms and conditions mentioned in your policy. In case, you are admitted in a Non-network Hospital, you need to settle the bills directly to the treating hospital and then seek for re-imbursement through your TPA.

What is cashless hospitalization mean? Can I just walk into the network hospital and get admitted for treatment free of cost?

First, you should understand that, there is no free treatment. It is the insurance company that bear the cost of your treatment either fully or partially on your behalf depending upon your policy terms.

TPA of that particular health insurance companyis theone that settle the bills on behalf of the insured customer as it is the mediator betweenhealthcare service provider (Hospital) and the health Insurance company and also your corporate company.

However it is important to understand the role of a Hospital in any given cashless hospitalization. The Hospital is only a facilitator helping the patient and TPA and has no authority to approve or disapprove any request for cashless hospitalization. All procedures are according to protocols lay down by the Insurance Regulatory and Development Authority (IRDA) with respect to cashless hospitalization.

Planned Hospitalization and pre-authorization procedure

When youconsulted a doctor for a health problem, the doctor if advised to get treated better on admission or for surgery, he would give advice on the probable date of hospitalization, then, you can apply for approval of the estimated hospital expenditure directly to your TPA at least 4-5 days prior to the date of hospitalization.

Our Insurance department and Insurance coordinators will help up you in assisting through the pre-authorization procedure, but they are only a facilitators and can in no way influence the decision on the approval, the approval can be turned down depending upon your policy.

You can contact the Insurance help desk forthe documents to be submitted for any pre-authorization procedure.

Collect the pre-authorization forms pertaining to your TPA at the help desk, you need to fill the general details of your health Insurance policy (the Insurance help desk will assist you in case you feel any difficulty). Details regarding the treatment recommended for you need to be filled in by your treating doctor and is duly signed by the Doctor. (Do not attempt to fill this section)

Once the form is completely filled in, Insurance Help Desk will fax the form to your TPA. You will be informed about your approval status by help desk and also by your TPA.

Emergency Hospitalization:

The Insurance help desk will help you in case of emergency hospitalization on a fast track basis and works with your TPA and may likely get approvals within 3 hours during any working day.

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