My mother is a cancer patient. She is having her surgery(CRS with Hipec) after six cycles of Chemo. When i inquired the insurance desk, they say if i would opt for cashless claim( tamil nadu government pensioners insurance)they would not be providing any bills. But if we directly go for payment they would be giving us bills. Then we claim reimbursement for our insurer on our own. What is the reason behind this, they are not explaining us why? and asking us to deposit 3 lakhs rupees as advance and we would not be given any bill. It's a private hospital.
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If you are depositing Rs 3 lakhs you must get a receipt
2) always opt for cashless claim
3) bills must be forwarded to insurance company
The Insurance Regulatory and Development Authority of India recently made it mandatory for medical insurance firms to authorise cashless hospitalisation within 1 hour of a request being made, and within 3 hours for a final approval at discharge
- According to Indian Medical Council (Professional Conduct, Etiquettes and Ethics) Regulations, 2002, the hospital is under obligation to provide all documents relating to treatment within seventy-two hours of demand.
- Hence , the said private hospital cannot refuse to comply the regulations of IMC .
- You should ask for the receipt if going to pay the amount
- However, you can approach the Insurance company for the payments.
Dear Client,
Regarding the hospital’s not having bills ready with the authorities for cashless claims, it may be because of organisational internal billing and reimbursement policies of Tamil Nadu government pensioners insurance. This is because they have the flexibility of direct settlement with the insurance provider, although they don’t provide detailed bills for the patients. . Thus, when choosing the option of direct payment, they present bills as part of the essential observance of the procedure that is required if you consider receiving a refund. The actual fact that one has to pay an amount of 3 lakhs in advance shows that normally this coverage pays for 80% of the claim, leaving the actual bill amount to be paid by the patient; however, not providing a bill in a ‘cashless claim’ seems very non-transparent. To determine why such a policy is implemented, it would be more appropriate to press the hospital for answers or contact the insurer if those are the terms of payment.
The tariffs for many surgeries are fixed in packages. But disputes arise on what is covered or not in the package. (Insurance firms) disallow certain billing and negotiate rates,"
Delays arise from both insurer-related issues and hospital-related issues, such as hospitals not adhering to all insurance provider requirements."
In cashless claims the hospitals are unwilling to provide bills it may be because of organisational internal billing and reimbursement policies of Tamil Nadu government pensioners insurance.
The insurance industry, as well as the medical sector in general, is awaiting the establishment of a health regulator that can standardise treatment costs and processes across hospitals.
A customer having multiple health insurance policies can decide the order in which they want to make a claim,
Insurance companies will have to coordinate with each other, not policyholders."
For now if you pay the amount demanded by hospital, you obtain a receipt for the payment made and get it reimbursed from insurance company
you should file a complaint before the insurance grievance.
It’s illegal you can file complaint against them before consumer court
