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Know what can you do when hospitals deny your COVID-19 cashless claim?
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What can you do when hospitals deny your COVID-19 cashless claim?

If you are a victim of COVID-19, then your medical treatments might become expensive in hospitals. Since Covid requires hospitalization for many days, you can’t afford all costs when it comes to treatments. Therefore, as a policyholder, you should check whether your insurance provider offers coverage for COVID-19 or an insurance company that provides cashless hospital coverage, which will help save money to a large extent. This will help a lot to manage your costs with ease while reducing stress and other problems.  

Having cashless health insurance will allow you experience peace of mind from unwanted worries. This is because an insurance company will pay the amount directly to your hospital where you are undergoing treatment. However, make sure that your chosen hospital has a cashless facility that will help avoid risks. You should know how to overcome the issue effectively from experts or other sources. As a policyholder, you should ensure that your Covid treatment doesn’t affect your hard-earned savings after buying a health insurance plan. 

How to deal with COVID-19 cashless claim denial? 

  1. Get in touch with the TPA
  2. Get treatment on priority even on reimbursement coverage
  3. Approach a non-network hospital for COVID-19 treatment
  4. Know the reasons for your cashless claim denial
  5. Register a complaint against a hospital
  6. Lodge your complaint to the appellate authority

 

1. Get in touch with the TPA

When your COVID-19 cashless claim gets rejected by a hospital, then you should make a formal request to the third-party administrator (TPA) in the network hospital. IRDAI has mentioned that hospitals shouldn’t put policyholders to inconvenience when it comes to cashless claims. Therefore, you should contact a TPA in case of denial to resolve the issue as soon as possible. If you are still denied admission to a hospital with a cashless claim, it is wise for you to lodge a formal complaint against your insurer. 

2. Get treatment on priority even on reimbursement coverage

The cashless facility enables you to reduce your burden when you want to undergo treatment in a hospital. However, you should go for another network hospital when a particular hospital does not approve your claim. This will help reduce your out-of-pocket expenses significantly to avoid worries. 

At the same time, you can also opt for reimbursement mode when the situation is still critical. This will help get the money later, and you should know about the reimbursement method in detail. A cashless health insurance plan offers solutions for availing funds during medical emergencies. Ensure that your healthcare provider follows the claim process correctly to overcome denial and other problems. 

3. Approach a non-network hospital for COVID-19 treatment

cashless insurance policy makes you stick only to the network hospitals when you are looking for COVID-19 treatment. At the same time, a hospital might reject your cashless claim that results in various problems. However, you can choose treatment at a non-network hospital on a priority basis to save a patient’s life with a reimbursement method. This, in turn, gives ways to claim your expenses with your insurance provider after the treatment gets over. 

Although it will take some time to receive funds, it is one of the ways to get treatment in a hospital on a priority that helps overcome the problem. 

4. Know the reasons for your cashless claim denial

As a policyholder, you should know the insurance claim denial reasons in a hospital for COVID-19 treatments. Contact your insurance provider immediately to inform them of the details, which will help solve the problem. In addition, it is wise to check with your network hospitals to know whether they approve a cashless claim for COVID-19 or not. This, in turn, paves ways to save your time, and you can avoid the hospitals that don’t have a cashless facility. 

5. Register a complaint against a hospital

It would be best if you considered registering a complaint against the hospital when a hospital is denying your cashless claim admission. First, however, you should communicate with your network providers to solve the problem as early as possible. When they don’t address your issue, you should make a complaint to the concerned authorities for further action. 

In most cases, an insurer will follow its course to register a complaint against a hospital, and you should file your own complaint to get solutions at the earliest.  

6. Lodge your complaint to the appellate authority

If you are not satisfied with your hospital and the insurance company’s services, then you should consider lodging your complaint to the appellate authority. 

You should know how to appeal insurance denial step by step that will help achieve goals to a large extent. First, file your complaint on the Integrated Grievance Management System (IGMS) website to escalate the same. Next, go to the website and register yourself by providing certain information such as your age, gender, date of birth, address, and other details.

On the other hand, they are applicable only if you are a first-time user. Otherwise, you can log on to the website by using your credentials. It would be best if you generated a complaint in the portal after generating your credentials. Ensure that you have adequately complained after verifying everything.

Also, make sure that you have submitted the necessary details or documents that support your complaint. Finally, you should check the status and updates on the website after filing your complaint. IGMS will review your appeal, and you should wait for some days to know the final results. 

A cashless claim allows you to save a lot of money on COVID-19 treatments. At the same time, you should know what to do if a hospital denies a health insurance claim. Follow the above steps that will help you overcome the problem effectively. Not only that, you can claim your amounts from your insurance provider that gives ways to manage your overall finance. Health insurance policies involve different types, and you should make a detailed study of them before investing money. Ensure that they don’t have the cap on a cashless claim in the network hospitals to help get high-quality treatment for COVID-19. Also, you will get maximum protection from the financial burden and other problems to lead a problem less life.