Pre-Authorisation (of Cashless Claims)
Pre-authorisation of cashless claims in health insurance refers to the provisional approval of the claim by the insurer before the treatment starts. Pre-authorisation results in quick turnaround time and cashless claim settlement for the claimant.
The pre-authorisation process starts with filling out a form, detailing the diagnosis and line of treatment recommended, and sending it to the insurer. The hospital insurance desk can help you in the documentation process. The insurer reviews the details and approves the claim, if admissible. The cashless treatment at the hospital starts after the insurer pre-authorises the claim.
This process might take a few hours. Some insurers with quick turnaround times provide pre-authorisation within an hour. Once the approval is received, the patient is admitted, and the treatment begins. If the treatment cannot wait for the pre-authorisation of the claim, the treating hospital asks you for an initial deposit. This happens in case of an emergency.
The final claim approval happens before discharge. The hospital sends the discharge summary along with the bills to the insurer. The insurer scrutinises the documents and settles the claim directly with the hospital. The hospital refunds the initial deposit, if any, made by you.
The entire claim process is complicated and goes through various levels of scrutiny. Pre-authorisation helps the insurer in initial assessment of claim and facilitates cashless treatment for the claimant at the hospital.
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B
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