ICICI Lombard - Health Insurance Cashless Process
Posted by Deepak Mendiratta, Last modified by Deepak Mendiratta on 19 November 2020 04:23 PM
Cashless Process of ICICI Lombard Health Insurance Plans

In health insurance policies, you can avail services in a hospital empanelled by the insurer without paying the bill. This is done via a 'cashless process' 
Your health insurance gives you this benefit as a covered member. While it is not the same as a credit card transaction, it follows its procedure and get the job done well. 
ICICI Lombard in fact has quite a smooth process for availing cashless benefits under retail health insurance or group health insurance (GHI)

There are a few important points to note while availing cashless benefits. 
  1. Check if the hospital you are going to is on the cashless network. Almost all hospitals are in a defined geography especially in metros or large towns and cities. None the less the mention of the hospital on the cashless network list, while often guarantees services, is still not always true. The lists are updated on periodic basis but may have instances where the services may stand withdrawn from either side ( the insurer or the hospital ) on a more recent basis. Best is to look up the website for more details 
  2. The hospital will typically have a desk manned by staff who are responsible for this cashless insurance paperwork with the insurers and third party administrators. Approach them
  3. They will have pre printed forms for availing cashless benefits. This form will be filled partly by them, partly by you ( if the gentleman at the desk likes you, he may fill it on your behalf except for the signatures) and the remaining will be filled by the treating doctor. The contents on this document includes the details of the patient, details of the policy, nature of ailment and the proposed line of treatment and finally the expected length of stay apart from the costs associated broken down into doctor charges ( surgeon. charges),  drugs, investigations and room rent
  4. The filled up document is sent to the insurer
  5. The insurer then pulls up the details of the policy under which the patient is covered,  checks for coverage of this treatment, checks if the costs proposed are aligned to the negotiated rate with the hospital and finally if all checks out well, authorises the amount
  6. This authourisation is interim and often not the whole amount asked by the hospital. The balance comes in through the same back and forth at the time of discharge
  7. This authourisation is a green signal of sorts to the hospital to go ahead with the treatment
Note - there may be time when the insurer or TPA may raise a few queries if something is not clear. These queries relate to either more information on the line of treatment and nature of symptoms, ID proof of the patient or costs being charged. These are mostly to be resolved by the hospital.  Having said that, please be on top of it always. Any such queries, till responded, will result in non-authourisation of the cashless approval.  Sometimes this can cause delays in treatment or worse, you may end up paying the bills
Always have the photo ID proof of the patient and policyholder ready to be provided along with all documentation. 

If you need any support and you are our customer, do send us an email on Assist@PlanCover.com  

Happy Health to You

PS - This article applies as much to Group Health Insurance Policies as it does to Retail or Family Floater Health Insurance Plans

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