Cashless hospitalization is when the insured person doesn’t have to pay a single penny out of his pocket in case of a hospitalization or surgery and the entire hospital bill is cleared directly by the Insurance Company.
For the cashless hospitalization, the Health Insurance companies collaborate with a list of hospitals after checking the quality of service they offer and discussing the rates of different medical treatments. Such hospitals are called as the ‘Network Hospital’ of the respective Insurance Company. If you purchase a Health Insurance policy
from a particular company, you are eligible for cashless hospitalization only in their network hospitals.
Every Health Insurance company
is represented by a Third Party Administrator (TPA) which will be a mediator between the Insurance Company and the hospital. It is the TPA’s responsibility to accept or reject claims and coordinate between the hospital and the Insurance Company
For availing the cashless hospitalization facility you need to fill a pre-authorization form which is available at the Hospital or the TPA’s website. This form is filled by the patient’s relative to inform the TPA about the claim. They would need to provide your policy number and the nature of your treatment. Once the TPA receives the claim they investigate about the authenticity of the claim and accept or reject it.