Cashless Hospitalization – What You Should Know

What is Cashless Hospitalization?

Cashless hospitalization is a facility provided by the insurance company where the policyholder can get admitted and undergo necessary treatment without paying the hospital directly for the medical expenses. The eligible medical expenditure which is incurred is settled by the insurance company directly with the hospital. You can avail cashless hospitalization only in the hospitals that are part of your TPA's network. Medi Assist enables you to avail cashless hospitalization at a hospital that falls within your insurer's network and also entitles you to discounts and reduced package tariffs at these hospitals. Hospitalization and related expenses can be made cashless upon approval of pre-authorization based on your policy cover. It allows you the relief of no upfront payments from your pocket.

At Medi Assist, you can avail cashless hospitalization at our network of hospitals.

What is Emergency hospitalization?

Cashless hospitalization can be availed only at a hospital that falls within your insurer network, upon approval of your preauthorization application.

1. Search for a network hospital: Visit network.medibuddy.in to find a hospital that falls within your insurer network or click the 'Hospital' tile on your MediBuddy. The Hospital tile on MediBuddy also gives you full details for the list of hospitals including location, specialties, packages and more

2. During admission, present your Medi Assist E-card along with any other valid Government ID. You can click the 'E-card' tile on MediBuddy to view your MA ID card

3. Ensure that the hospital sends your preauthorization form to Medi Assist, your TPA. You will receive updates on the status of your claim throughout the lifecycle of the claim.

4. Medi Assist sends approval to the hospital. Further enhancement approvals may be issued on request, subject to the terms and conditions of the policy.

5. Track your claim in real-time:

   • Click the Claims tile on the MediBuddy app (OR)
   • Log into me.mediassist.in and click the Claims tab (OR)
   • Visit track.medibuddy.in to search claims by Claim ID, MA ID, or Employee ID (OR)
   • SMS ‘Claims (Claim Number)' to +91 966 314 9992

6. In case the request cannot be approved or if the expenses are not covered by your policy, you will have to settle the hospital bill in full and subsequently raise a reimbursement claim after discharge. Do remember that denial of a preauthorization request must not be construed as a denial of treatment or denial of coverage.

7. After discharge, the hospital will send all the documents related to your claim to Medi Assist for settlement.

   Do Note:

   • The list of network hospitals is subject to change, with hospitals being empaneled on a regular basis. To access the latest list of hospitals in your insurer network, visit network.medibuddy.in or use the GPS-enabled Hospital search option on your MediBuddy portal and app.
   • The hospital will ask you to pay for all the non-medical expenses in your bill.
   • You will have to pay for all pre-and post-hospitalization expenses. These can be claimed only after the settlement of the main hospitalization claim.

8. At the time of discharge, check and sign the original bills and the discharge summary. Do carry home a copy of the signed bill, discharge summary and all your investigation reports for future reference.

Note: In case of suppression of material facts or misrepresentation of facts by the hospital or the insured, the pre-authorization issued for the cashless facility will stand canceled. The insured will be liable to settle the hospital bill in full.

Circumstances under which cashless hospitalization may be rejected:

• If the information contained in the request is insufficient for Medi Assist to arrive at a decision and further information is not available for whatever reasons.
• The ailment for which hospitalization is sought is not covered under the particular insurance policy for reasons like pre-existing conditions, specific exclusions, etc.
• The insured has already exhausted the insurance coverage for the year.
• If the request is received after 24 hours from the time of admission and 6 hours before the time of discharge.

What is Planned Hospitalization?

You can now opt for cashless hospitalization using Medi Assist's cashless facility. Cashless is the most hassle-free way to undergo a planned cashless hospitalization. With typical cashless hospitalization, the pre-authorization process takes time and this can be stressful especially on the day of your admission to the hospital as you have to wait for long hours at the insurance desk at the hospital but with eCashless, you can obtain a provisional pre-authorization well in advance of your hospitalization. It also gives you full visibility into the estimated cost of treatment at any network hospital of your choice. All you need to do is carry your ID card, provisional pre-authorization on your MediBuddy app, and your Medi Assist E-Card while getting admitted to the hospital.