After completion of treatment, patient A checks with the treating doctor regarding his date of discharge. The doctor advises that he will review the condition the following day and accordingly suggest the further course of action. The next day, the treating doctor advises discharge and continues rounds of the entire ward. The resident doctor prepares the discharge summary and sends it to the treating doctor for approval and signature. The signed and authorised documents are then sent to the hospital billing department for final billing. Once the final billing is received, along with the discharge medications, the discharge summary and the final bill are sent to the hospital’s insurance desk (the third-party administrator, or TPA desk). The TPA retrieves the initial approval request received and sends the enhancement request to the insurance company for approval. There is a delay of two more hours here as the insurance desk is handling multiple requests. The insurance company reviews the request and provides approval within two hours, as per policy terms and conditions. This process is for a cashless transaction.
This process could have been even longer had A been discharged on a holiday (weekend or public holiday) when the facility or hospital would have been sparsely staffed.
But such situations can be managed efficiently. All that’s required is that the claimant know and follow the correct process. Naturally, while the medical emergency is in progress, it may be difficult for either the patient or the loved ones to focus on understanding how to proceed with a cashless claim approval or discharge thereafter. Therefore, it is best to sit down at the time of purchasing a health insurance policy or soon after and completely internalise the process so that when the need arises, you are aware of what must be done to make the most of a facility.
