Estimates and cost breakdowns ensure transparency in the claims process and give a comprehensive view of the costs incurred.
What you need to do now?
To ensure smooth claim processing, here’s what you need to submit:
- Cost Estimate: Obtain a detailed cost estimate from your hospital for planned procedures or surgeries. Ensure this includes all anticipated charges, such as consultations, diagnostics, medications, and room charges.
Based on the estimated cost of the treatment, Medi Assist will provide an initial or estimated approval. This amount will not represent the full estimate provided by the hospital but rather a partial sum that we agree to pay for the treatment at the time of discharge. Please note that this estimate may vary depending on the verification and scrutiny of the complete claim documents during the discharge process.
- Cost Breakdown: Ensure that every service provided is listed, with individual costs specified (e.g., procedure costs, room rent, tests, consultations, etc.), except for agreed packages with the hospital for particular treatments related to cashless claims.
- Pre-approval: If it’s a planned procedure, submit the cost estimate early for pre-approval. The process remains the same as the cost estimate. This helps prevent delays when the claim is processed after treatment.
What happens if you don’t submit these?
Failure to submit these documents may cause delays or rejection of your claim. Ensure you provide a detailed cost breakdown on time to avoid any complications.
By ensuring the cost estimates and breakdowns are thorough and submitted early, you’ll help speed up your claim process and ensure a smooth reimbursement experience.
