As humans, we are bound to fall sick and get treated. We may even get hospitalized at some point of time. As a person who may be covered under a health insurance policy and opting for hospitalization, these are some basic things you should know about hospitalization, claims, and expenses.
Read on to know some of the basics of hospitalization.
Hospitalization can be of two types:
- Planned hospitalization
- Emergency hospitalization.
Planned hospitalization happens when you have ample time to plan your admission to the hospital. For example, if your doctor advises a surgery for hernia anytime within a couple of weeks, you have time to plan your hospitalization. Emergency hospitalization happens typically in case of emergencies such as domestic accident or a road accident. One cannot plan such a hospitalization.
Benefits of planned hospitalizations
If you are aware of the fact that you or your family members require hospitalization in the near future, you can send prior intimation to Medi Assist to plan your hospitalization. Not only does this ease the admission and pre-authorization process, but it also helps reduce your overall cost of treatment wherever possible.
Once Medi Assist receives the intimation, we will help you plan everything including choosing a network hospital, opting for discounted packages, if available, and planning for cashless hospitalization. Here are the advantages of a planned hospitalization:
• You get a green-channel hospitalization which means that the hospital is aware of your impending admission and your wait time on the date of admission is significantly lesser.
• The Medi Assist executive helps you compare tariffs and facilities at various network hospitals so you can make an informed choice.
• You have the benefit of opting for discounted packages, negotiated by Medi Assist exclusively for our members, along with the benefit of cashless admission, wherever applicable.
• Even if your policy places a cap on your hospitalization expenses you can reduce your out-of-pocket expenses by choosing the discounted price available to you as a Medi Assist member.
Expenses associated with hospitalization can be classified as follows:
• Pre-hospitalization expenses: When you’re unwell, you will most likely consult a physician first, who gets relevant investigations done before advising hospitalization. Such medical expenses incurred before hospitalization are called pre-hospitalization expenses.
• Hospitalization expenses: All expenses incurred as part of your hospital stay as an in-patient can be termed as hospitalization expenses.
• Post-hospitalization expenses: Some part of your treatment may extend beyond your hospitalization. It may involve follow-up visits to the doctor, prescription medication, further investigations, etc. Such medical expenses are called post-hospitalization expenses.
• Domiciliary hospitalization expenses: This typically includes expenses related to domiciliary hospitalization – at-home medical treatment for more than three days for cases which in the normal course would require hospitalization. The exact circumstances / terms / exclusions related to domiciliary hospitalization would be spelled out in your policy document.
Apart from hospitalization expenses, your health insurance policy may also cover pre- and post-hospitalization expenses, and offer a cap for domiciliary expenses.
Depending on the situation and your policy coverage, you can make two types of health insurance claims:
• Cashless: The essence of cashless hospitalization is that the insured need not make an upfront payment to the hospital at the time of admission. You may not have any out-of-pocket expenses towards hospitalization in this scenario. Cashless hospitalization can be availed only at a Medi Assist network hospital and upon approval of your pre-authorization application.
• Reimbursement: A reimbursement claim is one where you pay all the expenses related to the hospitalization of the insured and claim a reimbursement of your expenses after discharge. Reimbursement claims may be filed in the following circumstances:
– Hospitalization at a non-network hospital
– Post-hospitalization and pre-hospitalization expenses
– Denial of pre-authorization for cashless facility at a network hospital.
Visit our website, www.mediassistindia.com, for the updated list of network hospitals.