Facts about pre-approval claim settlement - Fusion - WeRIndia

Facts about pre-approval claim settlement

Facts about pre-approval claim settlement

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.
Facts about pre-approval claim settlement

Facts about pre-approval claim settlement

  • 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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