When reading up on health insurance, you will come across a lot of jargon that might leave you confused. One such term that you may have come across is pre-authorization. In this article, we will take you through the meaning of pre-authorization in health insurance and how it works.
What is pre-authorization in health insurance?
Pre-authorization is the process in which the insurance provider approves a claim for cashless treatment before the policyholder gets admitted for hospital. Once the policyholder is informed that they require treatment, they need to intimate the insurer immediately in order to begin the pre-authorization process. The time taken for pre-authorization can vary between insurance companies. Some may take an entire day and others may sanction cashless coverage in a few hours.
Pre-authorization is available for planned and emergency treatment. In planned treatment, it is advisable to contact the insurer at least 4 to 5 days in advance. In case of an emergency hospitalization, you may submit the request after admitting the patient. Just be sure to fill up the pre-authorization form as soon as possible, preferably within 24 hours. During an emergency hospitalization, the treatment centre may demand a deposit from you as security; this amount will be returned later.
How to request for pre-authorization in health insurance?
Insurers have simplified their processes these days to ensure that policyholders get quick access to services. Here are the steps to follow when applying for pre-authorization in health insurance.
Step 1: Visit the insurer’s website and download their pre-authorization form.
Step 2: Fill up the form clearly with details of the treatment and cross-check to ensure that there are no discrepancies.
Step 3: Get the patient (policyholder) and attending doctor’s signatures in the relevant places marked.
Step 4: Submit the form online for the quickest possible processing of your request.
Note: If you are unable to submit the form online, you may opt to get it faxed across.
A few tips to keep in mind
Here are some tips to keep in mind when filling the pre-authorization form in health insurance.
- Submit the request for pre-authorization at the earliest to ensure enough time for cashless claim review and approval
- The pre-authorization approval is only valid for the dates requested on the form; any change in date has to be communicated to the insurer once again
- Contact your insurance provider / third-party administrator to follow up on the status of your request
- Always be completely truthful when filling up the pre-authorization form – do not hide any information about pre-existing conditions or any other health condition
It is important to note that even after pre-authorization comes through, the policyholder will still have to bear certain expenses out of their own pocket. These may generally include the costs arising due to co-pay as well as treatment and room rent caps in their health insurance policy. Do make sure to go through the fine print of your policy for more details.
We hope that this article has helped you. Take care.