I read with interest your article on ‘Cashless Mediclaim’ (Moneylife, 12 July 2012). I am a policyholder of Apollo Munich Insurance Company. I have not made any claim so far. I wish to point out the lacunae in the service of the insurance company about emergency hospitalisation on cashless basis.
A cashless hospitalisation is not necessarily cashless. A patient needing emergency hospitalisation will have to pay a security deposit in most of the network hospitals. It goes without saying that a policyholder, even with life-threatening medical condition, will not be admitted if he is unable to pay the security deposit before admission which he may not be in a position to do. But if he has already paid the premium, he should be admitted immediately on humanitarian grounds in case of acute medical conditions. The extra charge, not included in the policy, may be adjusted later on. The only condition for admission should be a valid insurance card and photo-identity proof.
A policyholder has to inform the TPA (third party administrator) and get authorisation from the TPA before admission, for getting cashless treatment. But it is often impossible to contact the TPA immediately in emergency situations—by email, fax or telephone on toll-free number.
The insurance company should provide a number to send an SMS to the TPA in such acute situations. The TPA should inform the concerned network hospital immediately for providing cashless treatment.
I also wish to suggest that all the details of a policyholder should be available on the computers of all the network hospitals to avoid any delay in admission for cashless treatment. The network hospital should contact the TPA on behalf of a policyholder who may be in an unconscious state and not in a position to contact the TPA himself. There is a thin line between life and death in a case of street accident or acute emergency conditions. The person needs to be admitted quickly to start treatment and save life.
Insurance companies should have a sympathetic attitude in such emergency situations. They should follow the above-mentioned suggestions to provide early, hassle-free cashless hospitalisation to patients.
Dr Ramesh Prasad, by email