Page 343 - Ebook health insurance IC27

Sashi Publications

13. This creates a panic situation and many times the insured are forced to pay from
their pocket and thereafter claim theamount from TPA/Insurance Company in normal
course due to emergency. In many cases it has been seen that TPA's delay the
process of authorization so that the customer pays from his pocket and then claims
reimbursement.

14. Generally the TPA's grant authorization foraparticular amount. If thecost oftreatment
exceeds that amount the patient must give it from his own pocket and then claim
reimbursement from the Insurance company if it is within the policy limits.

In case of Non-Cashless Hospitalisation/Emergency Hospitalisation:
In case of Non cashless Hospitalisation the insured must give preliminary intimation
about the claim within 7 days of hospitalization (The intimation period may vary from
company to company) to the TPA/Insurance Company. The notice would include the
following:-
1. Particulars of Policy number
2. Health ID card number and copy
3. Name of Insured Person
4. Address
5. Name of attending doctor
6. Name of Hospital
7. Nature of illness/injury

After the insured is discharged the final claim must be submitted to the company within
30 days from the date of discharge. The period of intimation may vary in insurance
companies.

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