Nobody wants to experience hospitalisation, but many times we can’t escape from it. This is called uncertainty. Where on one side it brings mental trauma, there it increases the pain if your Financials are not properly in place to face such kind of situation. I have recently experienced this, when my wife gets hospitalised and operated for some problem. Through this article I am sharing with you some of the learning which i had during the hospitalisation period. This is just to prepare you on how to better manage the hospitalisation cost.
1. Understand your health insurance policy first
I have observed that many people after buying health insurance policy starts feeling that they are fully covered of all medical costs, be it OPD expenses or hospitalisation. They are not aware of the general exclusions, specific exclusions, waiting periods on specific ailments and pre-existing diseases etc.
First thing first, call your health insurance agent or your HR people if you are still dependent on your employer provided policy (read: ensure you are insured) and ask for the complete details, so you will be better prepared to face uncertainty…both mentally and financially.
2. Keep your Policy details handy.
Many people depend on their agent for this. They think that whenever they need any kind of help they will call up the agent who’ll help them with the details. But this should not be the way. Keep the mediclaim card always along with you like other credit cards, pan card etc. or save the policy number and other details in your mobile phone to make it easily accessible.
3. Keep your medical records in order
Maintain a file carrying all the papers related to any and all of your past medical treatments. This on one side will help your doctor to understand the past medical history in detail and on the other; this will help to satisfy the insurer’s requirement of any document if they ask for related to this particular claim.
This had actually helped me when insurer asked for the first prescription of doctor with commencement date of the symptoms of disease. In my case the commencement date of symptoms was in 2008.
4. Visit the corporate desk in advance.
If the hospitalisation is planned, then do visit the corporate desk of hospital a day in advance to enquire about the empanelment of the health insurance company with the hospital and the documents they require to send for pre authorisation. Also do inform your insurer too for this. Though it will be difficult for an unplanned hospitalisation, but still if you have done your homework by following the above 3 steps, you will be able to face the situation confidently.
In my case, it was almost planned. But still I made one mistake of not enquiring about the empanelment from the insurer. I totally believed the admission desk guy, who after 6 hours told me that they are not empanelled yet. All this meant that cash less will not be approved and I have to bear all expenses from my pocket. (Read : keeping emergency fund)
5. Ask for packages.
Almost all the private hospitals offer different packages for different treatment. The package cost gets decided with the type of room you opt for. Either you go by the room type like single, double or deluxe which will lead you to a particular package or go with the package cost which includes cost of treatment and/or room rent charges and /or drugs & consumables and/or all consultations, investigation cost etc. Different packages have different compositions.
(Also Read Financial Planning case Study)
The package you opt for will not affect your treatment but surely the treatment cost. Go through the packages in detail and select as per your convenience and your affordability. Also keep an idea about the costs covered under your health insurance policy. My advice is to select the package as per your affordability and not as per the coverage available under your insurance policy. As higher the claim amount, lower will be the coverage available for rest of the year.
I was not aware of this. My doctor told me the cost as per the economy package which includes the room with 4 patient beds. For convenience sake I requested to upgrade the room to single patient bed room, without realising the effect it will give on the overall cost. The difference in the rent of Single and 4 bed room is only Rs 3000/- but the treatment cost got increased by Rs65000/-It is only after the shock I got at the time of discharge from hospital, I came to know about this.
Just click here to have a look at cost of different cardiac packages offered by Max hospital Mohali.
6. Keep check on change in the treatment/procedure.
Every particular procedure/surgery has a different cost structure. If at any point of time your doctor feels to do some additional procedure or change some of the treatment, it may attract more cost towards whole thing. Better be aware of all the costs at all time.
In my case the doctor has informed us about the change in the treatment and even took the approval from us for that. As all the procedures for this treatment sounds like of the same name so I didn’t bothered to ask the change in the cost, which in turn has costed me with Rs 20,000/- more.
7. Do go through the discharge summary in detail.
If you are going through the pain of non-approval of cash less treatment, and thus has to pay all the cost out of own pocket then this step is of much importance to you. (read : Managing Financial emergency)
As in the next few days you have to put the case for reimbursement, so need to arrange for all the documents required to be submitted along with the claim form. Here you may take the help of your Health insurance agent and enquire about the requisite documents. Before getting discharged, do check with the hospital discharge summary that all the details required under claim form are present there, to avoid future discomfort.
My wife’s discharge summary did not mention with the prescriptions/advices of the medicines used in the whole treatment, to which insurer raised the concern.
In my case the cost involved was not too high, so it got managed with the emergency fund and other liquidity available with me. But had this involved huge money, then I surely would have been in a financial soup. It bothered me, as there was no cash less facility available so even my health insurance policy could not help me. But this whole experience has given me good insights on how to manage the overall hospitalisation cost.
Do share ,If you had any such kinds of experience . It will surely be helpful for other readers.
Manikaran, thanks for this informative article
I need to clarify one thing that if i understands my policy well and it has passed all the waiting periods, than do i have to check for hospital packages ? as now onwards all my treatment cost will be paid or reimbursed by Health insurer only?
Sameer, this is important even if you have crossed all the waiting periods.
Just like hotels , private Hospital packages also comes with different comfort and combinations and thus different costings. There’s actually huge difference in the economy and deluxe packages of hospital. One should opt for that package which he/she otherwise would have gone for had he not been insured. As i have written above that the more the treatment cost is, lower balance will left for rest of the year in mediclaim.
Also, you should check the treatment cost limit in your hospitalisation policy…which gets reflective in the room rent limits. Mediclaim covers only the cost of that treatment package which comes under the room rent limit.
Manikaran, what packages you are talking about?
Rajat, visit any pvt hosptal and ask for a particular treatment cost. for e.g angioplasty treatment.
You will get alist of different packages where the cost depends on the type of room you opt for.
Check out the following link, which will get you the package cost of Heart ailments treatment , as done in the Max hospital mohali.
How important is this to inform the insurer in advance? If we don’t do that, will they create any problem in claim settlement?
This is not that important, but it is always advisable in case of planned hospitalisation. This will help you in 2 ways…one, you will get confirmation as to if your hospital is empanelled with Health insurer or not …and secondly, you come to know the documents you will require to carry along with you for pre authorisatin request.
[…] 5. If Parents are fit and fine then select Policy with No limits on room rent .This is because the total hospitalisation expenses depends on the room rent only.(Read : Managing Hospitalisation cost) […]