Facts about pre-approval claim settlement | Fusion - WeRIndia

Normally insurers assure to settle claims quickly with pre-approval authorization.

Policy holders see this as useful in times of medical emergencies.

But, pre-approval claim settlement does not always mean that your insurer will settle all your bills in no time.

Read on the article to know the facts about pre-approval claim settlement.

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• Cashless health insurance is a layered process and all the bills are not settled instantly.
• For these cashless policies, you have to get pre-authorisation from the insurer which means the claim is payable by the insurer.
• It is just an acknowledgement but not a guarantee by the insurer.
• The policy holder should fill all personal and policy details in the form. Then the form will be filled by the doctor stating the health ailment and treatment.
• This form will be sent to the insurer after it is duly filled by the estimated details from the billing department with supporting documents.
• The insurer may approve or ask for additional documents to approve it.
• Some hospitals may demand an initial deposit in case of medical emergencies as they do not want to wait for pre-authorisation. However, pre-authorisation is a quick process these days.
• Pre-authorization means that the insurer sanctions the initial amount to admit into the hospital and agrees to pay the claim subject, the final invoice from the hospital.
• The actual payment is made at the time of discharge. This is usually a lengthy process. The insurer will have to be sent a discharge summary to settle the claims. Discharge summary itself is a lengthy process.
• And after receiving the discharge summary from the hospital, the bills are settled by the insurer after a thorough scrutiny in several levels.

• The final claim is settled subject to the decision of the insurer.
• Any non-payable amount by the insurer is to be borne by the policy holder.

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