For me, hospitals have always been about work and treating sick people with all kinds of ailments. But that perspective changed when my father got admitted to the cardiac ICU at the hospital I was supposed to start work at in 2 days. I saw a whole new side to it. A side where a security guard had to permit me to let me into an ICU. What I had taken for granted before was something that came to bite me in my back. Thankfully, becoming a prospective employee and some pull got me in without much hassle for the rest of our brief stay there.
I, for the first time actually understood the proceedings of insurance and their policies. At first, I was mostly ashamed that I had no idea whatsoever about insurance policies being a health care provider. But hey, there's a first time for everyone and I am glad mine happened, albeit the hard way.
In comparison with the hospital where I imbibed the tricks of the trade (read as Davangere, a small semi urban town where you lawyers and filthy rich doctors breed), corporate hospitals are a whole new chapter. Corporate hospitals have changed the dynamics of health care. Health insurance, a thing that was almost unheard of in India in the last century is the way health care rolls these days (in an urban area of course). It has also reduced the burden of middle class fellows like us. But with the bouquets, come the brickbats. Remember, that insurance companies are very good in convincing you to buy a policy and are very happy as long as you're paying your annual premium. But when it actually comes to doling out money for your hospital expenses, they don't give in without a tough fight from their end. Query after query finally resulted in a 70% payment from their side and us getting discharged after 10 whole hours!! In a small way, I felt pretty cheated. Looking back, all of the above said about insurance companies would seem very obvious. But unfortunately I never paid heed prior to this experience. So here I am sharing my experience with you briefly so that you don't feel as lost as I did.
1. KEEP COPIES OF YOUR INSURANCE POLICIES FROM THE PREVIOUS YEARS TOO. DO NOT DISCARD THEM. (They are retards who want to see your policy from 3-4 years even though they have documentation of your loyalty to them)
2. As soon as your kin gets admitted, hunt for the insurance and billing department (I&B)of the hospital. They'll guide you with the procedure. You just fill in a form of your TPA and hand it over to the staff so they can email it to the respective TPA for approval.
3. Approval should roughly take anywhere between 2 hours - 24 hours depending on the insurance company.
4. Once you get a nod for discharge, inform the I&B department. Be nice to them and bat your eyelids to get your work done quickly. (Everybody is put off by shouting. Even though it can be frustrating, remember that they are also tending to a lot of other patient requests. Hence, be patient and dignified).
5. Insurance companies will never sanction the amount right away. They need proof for everything and will always have a gazillion queries to know how genuine the illness was. Let the staff of the hospital deal with that.
6. Also, constantly check with your insurance company the status of your submission by dialing their toll free number. A lot of times lacunae in communication may result in unwarranted delays.
7. Pray that everything gets processed fast.
8. Once the amount is sanctioned, walk out of the hospital better and happy.
(The above mentioned is merely for the cashless facility. For the reimbursement facility, I'll have to wait to learn all about it)
With changing times, sedentary lifestyles and a polluted environment, more people are falling sick. When prevention isn't an option/happening, cure is the next best thing. With more corporate hospitals and tertiary care hospitals cropping up, tiny nursing homes are disappearing. The entire nation is also aware of the rising cost of health care in our country. So my personal recommendation to everyone is to buy a health insurance policy as soon as possible. Make sure that you find a good one which fits your bill and processes claims fast. You never know when you may need one.
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