I'm sharing list of rules to follow, at our hospital, whenever an insurance patient comes. This may be helpful to guide to some
*Whenever insurance patient comes,*
1) Ask for which insurance they have?
Cross check with our list and let them know the availability of that insurance cashless facility. If that particular insurance is NOT available at our Hospital, tell them that we will provide all the bills and they can go for REIMBURSEMENT.
2) If the cashless insurance facility is available at our Hospital, ask them "How much insurance coverage do they have"?
And note it down.
3) Tell patients that we will take Pre Authorization and as per the approval we will notify you.
4) Once the approval comes, we will tell the patient that they have to fix date and "caution deposit" of 1000 Rs has to be taken as advance, which will be refunded after surgery.
5) Patient should be informed that they will have to keep ready with the amount of surgery, in case THEIR insurance company doesn't approve final bill OR delay in providing final approval, it is patients responsibility to deal with THEIR insurance company and PAY the amount before discharge.
6) If they are in HURRY and want to get discharged early before receiving Final Approval from their insurance company, then they have to pay the bill and get discharged and we will refund the amount if insurance company provides final approval.
7) Pre Op workup, Pharmacy and Kit are not included in cashless facility. We will provide bill for that, they can go for Reimbursement for the same. Because insurance will reimburse them 30 days before and 60 or 90 days after admission and surgery.
8) If they want to go for higher package surgery which is not covered by their insurance, then they have to go for Reimbursement. They have to get the surgery done with payment and we shall provide them bills and they can get reimbursed from insurance company.
9) If they have more than 1 insurance company coverage, we will provide cashless under only one insurance company and will provide "bill for the remaining amount only". That they have to get reimbursed from another insurance company.
10) If patient asks for documents of bill and notes, it will not be provided. They can take photo of approval letter. But we will not provide them any notes since it's THEIR insurance company rules and all the documents will be given to their insurance compay and they can go and ask them for the documents.