A hospitalization for yourself or your family member is a challenging time. Planning the treatment in advance as far as possible is the best way for you to go in for a medical procedure.

  • You get an approximate of the cost of your treatment beforehand

  • You have a fair idea of your out-of-pocket expenses

  • You have one less thing to be worried about during the hospitalization.

1. How to start

To start a cashless claim, you would need to plan your treatment in a network hospital of your insurance provider. You can visit the network hospital list on your Plum dashboard by clicking Home > Health insurance

2. Initiating a claim:

  • You can walk up to the TPA (Third Party Administrator) or hospital desk 7 days before the date of admission.

  • Documents you will need to share -

  1. Filled out pre-authorisation form shared by the TPA desk,

  2. PAN & Aadhar (carry your original or a government approved copy)

  3. Your health ID card (downloaded from your Plum dashboard)

3. What happens next?

The TPA desk sends your documents to the insurer. You wait to hear back on the approval within a working day from the hospital desk itself.

You can loop Plum in at this point (if you haven't already), and we'll be happy to share updates on your claim status along with guiding you throughout the process.

4. Approving the pre-authorization:

  • If all the documents submitted are completed and correct, an approval from the insurer takes approximately 4 working hours to come through.

  • The approval letter from the insurer breaks down all the deductions. We recommend that you go through these in detail and seek any required clarifications with the help of the Plum Claims team.

5. Admission

More often than not, there are additional treatments required than the ones that you planned for. You will need to seek a final approval of the increased claim amount following the same steps as you did earlier - by reaching out to the TPA desk in the hospital and working with the Plum Claims team to get a status update.

6. Final approval

The final approval (or rejection) comes in from the insurer along with the discharge summary. Once again, we recommend you go through the fine-print of all deductions and seek all clarifications with the help of the Plum team. We're there to help you raise any disputes if the claim amounts are not justified.

7. Discharge

  • The discharge summary received by the insurer would need the treating doctor's signature on it.

  • Since the patient can only be discharged after this slip is signed, we recommend that you initiate this process at the right time (once you know the date of discharge).

  • This discharge summary will be important for a reimbursement claim post the hospitalization.

We hope this was helpful! To raise a cashless claim request, you can start your journey through selecting 'use my insurance' on the Plum dashboard and our Plum claims team will reach out to you. Here's a demo video on generating a cashless claim.

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