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Records in this category
- What is a TPA?
- What are the facilities offered by a TPA?
- What do you mean by Network /Non-network Hospitalization?
- What is Cashless access/Cashless Facility?
- What documents should one obtain before discharge from the hospital in case of cash less facility availed?
- What documents are needed for processing claims if the treatment has been done in a non-network hospital or in a network hospital where cash less facility was not granted / availed?
- When will my claim be reimbursed?
- Can I get Cash less facility / Reimbursement in the case of pre-existing diseases?
- How do I get a list of network hospitals of TPA?
- During the course of my treatment, can I change the hospitals?
- I am not keen to avail of Cash less facility. Can I go in for reimbursement?
- What is the benefit of carrying a health card?
- Should the claim be submitted to the Insurance Company or TPA?
- Will the medical costs be reimbursed from day one of the cover?
- Will I get the entire amount of the claimed expenses?
- Can any claim be rejected or refused?
- In case of part settlement can an insured claim for the balance amount?
- How can I check the status of my claim?
- What is the procedure to get Reimbursement in case of emergency hospitalization?
- What is the procedure to get Reimbursement in case of planned hospitalization?
- How does one get Reimbursements in case of treatment in non- network hospitals?
- What are the situations under which one may be denied cashless hospitalization?
- What is the information one needs to furnish while intimating a claim?
- What if I don’t remember my Card Number and Policy Number and I am in an emergency situation?
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Sticky FAQs
Health Insurance » Claim Process
ID #1081
What are the situations under which one may be denied cashless hospitalization?
1 If there is any doubt in the coverage of treatment of present ailment under the Policy
2 If the information sent to TPA is insufficient to confirm coverage
3 If the ailment/condition is not being covered under the policy
4 If the request for pre-authorization is not received by TPA in time
In such a situation, the Insured can take the treatment, pay for the treatment to the hospital and after discharge, send the claim to TPA for processing.
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Related entries:
- Are there any sub limits like room rent, etc?
- Is there a cover for pre-existing medical conditions?
- Do we need to pay upfront in case of a medical treatment and then claim, or the insurance policy will pay upfront?
- What is a TPA?
- In case medical treatment is required, is there any need for any pre-approval before hospitalization?
Last update: 2010-09-28 15:45
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Revision: 1.0
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