MEDICLAIM / CASHLESS
Kalsekar hospital is on pannell of almost all the cashless and managed care insurance companies. All private and public sector medical insurances are available under cashless facility at kalsekar hospital. List of companies can be seen at #
How to avail cashless facility ?
Every individual having medical insurance from any insurance company is provided with unique ID by the insurance company. In case of corporate insurance patients company ID is sufficient to process the claim. It is mandatory to carry this ID during admission of patient at Kalsekar Hospital.
Once you provide this ID to insurance desk at Kalsekar Hospital, desk will do further procedure to contact your insurance company for getting approval for admission and treatment. You will receive verification call from insurance company or TPA regarding admission to Kalsekar Hospital.
What happens if insurance company denies the claim ?
In case of denial hospital will try to understand the reason for denial and inform the patient and relatives accordingly. In case of insurance being valid and still insurance company denies for payment under cashless facility. Patient will have to settle hospitals bill in cash and avail the reimbursement facility from insurance company.
What are the reasons of denial of claim ?
Usually there are three main reasons for denial of cashless claim.
- Exclusion i.e. disease is not covered under your policy.
- Waiting period i.e. you disease has waiting period in your policy, it is usually between 2 to 4 years for different conditions.
- Pre existing i.e. your disease is considered as pre existing when you availed for policy.
Do i need to pay any amount even if my claim is accepted under cashless facility ?
Yes, most of the policies (personal or corporate) have component call ‘copay’. This is mentioned in your insurance policy. Copay component ranges from nil to 20% of final bill of hospital. Copay amount is collected by hospital from patient during final settlement of bill.
What are other situations when I have to pay from my pocket ?
This happens when you have availed for higher services than allowed under your insurance policy. For e.g. patient stays in higher room category than allowed by his insurance policy.
Are there any services not covered under cashless facility ?
Yes, usually patient’s diet/ food, investigations before admission, pick up and drop of patient, on discharge medication, follow up, etc. are not covered under cashless facility by insurance providers. Some of these expenses are reimbursed separately by insurance companies.