Axillary Breast Tissue Removal Under Insurance - 100% Cashless

Expenses Covered by Health Insurance for Axillary Brest Removal

How to Claim Health Insurance for Axillary Breast Treatment?

There are two ways a patient can use the health insurance policy to cover the expenses of axillary breast removal – cashless claim and reimbursement claim. The process to get these claims are explained below.

Cashless Claim Process for Axillary Breast Removal

A cashless claim allows the patient to pay the hospital bill upfront.  Through this claim, the medical bills are settled between the hospital and the insurer directly. To avail of the cashless facility, the treatment should meet one of the following criteria-

• The patient is hospitalized for 24 hours.
• The surgery is covered under daycare procedures.

When these requirements are fulfilled, the patient can use health insurance for cashless payment only at a network hospital of the insurance company. The claim is processed in the following steps-

• Schedule the surgery at the hospital and provide the necessary documents to the TPA (third-party administrator).
• Fill out the cashless claim form and submit it to the TPA.
• The TPA team will submit the claim form and respective documents to the insurance company.
• The insurer will validate and verify the documents and the proposed treatment plan. The patient will also receive a call from the insurance company to confirm the legitimacy of the claim.
• Once the cashless claim is approved, the patient will be notified through a text message and/or email.

The hospital bills are settled before the patient’s discharge. To ensure that the patient doesn’t face any difficulty or delay during the discharge, it’s always recommended to inform the insurance company regarding the treatment 2-3 days before the surgery is planned. This will streamline the process, and the claim will be authorized as soon as possible.

Reimbursement Claim Process for Axillary Breast Removal

The reimbursement claim can be requested during and after the treatment. This facility is availed by the patient when he/she is getting treatment at a non-empaneled hospital. Through this claim, the patient can get reimbursement for the amount paid upfront at the hospital for the treatment.

While the cashless claim is handled mostly by the hospital’s insurance team and the insurer, a reimbursement claim is handled by the patient without much assistance from the hospital authorities.

The steps to get a reimbursement claim are explained below- 

• Inform the insurance provider about the treatment during the hospitalization and after discharge.
• Make the payment directly to the hospital and obtain the reimbursement claim form online or through the insurance agent.
• Provide the required documents, such as discharge summary, ID proof, etc., and submit the form within 30 days of discharge. If delayed further, the patient won’t be eligible to get reimbursement.
• The insurance company will review the documents and provide approval after verification.
• The sanctioned amount will be credited to the patient’s account directly.