4 min read.Updated: 21 Dec 2016, 05:09 PM ISTMunish Daga
In the case of pre-planned hospitalisation, it is possible to get the process of cashless health insurance and eligibility check started before the patient is admitted
Making the adoption and utilisation of health insurance customer-friendly, simple and jargon-free for the policyholder is a continuous process that each industry stakeholder is tackling in its own way.
Low adoption numbers, and frequent accounts of health insurance related grievances point to the fact that there is a lack of awareness and gaps in customer service. Understanding customers’ needs and formulating policies that can best suit them, as well as equipping them with complete knowledge of the fine print is crucial to customer service and satisfaction. Undoubtedly, there is a lot that needs to be done.
With the advent of corporate employers providing cashless health insurance group covers to their employees, as well as a slow but steady penetration of cashless retail health policies, cashless health insurance is laying the foundation for more customer-friendly healthcare policies in the country.
In a cashless health policy, the policyholder pays only a small percentage of the final bill (10-20% co-pay) and the rest is settled between the hospital and the payer (insurance company or third party administrator).
In the case of cashless policies, an estimated amount is pre-approved by the payer when the patient is admitted. Thus, the patient does not have to bear a financial burden that is typical of medical expenditures during hospitalization.
There are other benefits and features that policyholders can use to their benefit and reduce trouble at the time of hospitalization.
For example, most policyholders do not know that in the case of pre-planned hospitalization, it is possible to get the process of cashless health insurance and eligibility check started before the patient is admitted to the hospital, i.e., a few days in advance.
Eligibility checked in advance: As soon as the policyholder learns that treatment is required in the next few days, she can raise the request for pre-intimation with the hospital or the payer directly. When the payer receives this request, it will initiate the first step of pre-authorisation, which is eligibility check.
In this step, the payer verifies the policyholder as a customer, and checks details such as past history of insurance usage, whether the treatment is eligible for insurance, and the sum that can be pre-approved for the upcoming treatment.
Let’s take the case of a cataract procedure. Upon finding out the need for treatment, and fixing the schedule for the surgery, the payer can be pre-intimated so that an eligibility check can be done well in advance.
Fulfilling all the criteria of eligibility, the sum for the treatment can be approved even before the patient enters the hospital.
Further, along with the pre-intimation details, carrying electronic copies of health card and ID proof on your smart phone at the time of pre-authorisation will ensure that you don’t have to run around to get these documents.
Lesser waiting time: For a pre-planned hospitalization, pre-intimating the payer will save you the trouble of getting the paperwork ready and starting the process of pre-authorisation at the time of admission. Having the pre-intimation number, the treatment can start immediately upon getting admitted.
Also, by starting the health insurance process early, the policyholder can significantly reduce the waiting time she would have to otherwise experience.
Another example is that in the case of child birth, the soon-to-be parents can inform the payer and/or the hospital in advance so that the baby, when born is registered in the policy as a dependent.
Having done so in advance will ensure that the newborn is insured should the need for any kind of treatment arise after birth and that the parents don’t have to pay out of pocket for the treatment.
The policyholder can start the pre-intimation process by notifying the payer as much as a week to even 48 hours in advance.
For cases such as appendicitis, cataract, maternity, and other pre-planned hospitalizations, the policyholder can notify the payer and/or the hospital, share details such as policy ID, required identity proof, and initial details of the treatment required to start the insurance process in advance. Many payers also generate a pre-intimation number, which the policyholder can produce at the hospital upon arrival. Furthermore, payers are also enabling their customers to raise such requests through mobile apps and chat platforms on their websites.
When it comes to planned hospitalization, a simple proactive step from your side can ensure that your experience at the hospital and while utilising your health insurance is seamless and quick.
To simplify health insurance, both insurers and hospitals are using simple customer-friendly tech tools such as mobile applications, SMS and e-mail updates, to ensure more transparency, and seamless channels of communication with the consumer at all times.
While these efforts evolve and continue to find ground, as a consumer, being more informed and investing some time in understanding how your policy can truly benefit you in the time of need is essential.