Pristyn Care is dedicated to patient-first care and provides optimal care under all circumstances. We accept all health insurance policies to provide advanced care for benign and cancerous breast lumps. Our cashless payment service allows the patients to utilize health insurance or a mediclaim policy to cover the breast lump treatment cost.
Whether the breast lump is benign or malignant, the insurance claim process remains almost the same. There are two ways a patient can claim health insurance for breast lump treatment- cashless and reimbursement.
Cashless Claim Process
Through cashless claims, the medical bills of the patient are settled between the insurer and the hospital. Typically, to avail the cashless facility, the patient needs to inform the insurance company at least two days before the surgery (in case of planned hospitalization) or within 24 hours of hospitalization (in case of emergency).
An individual can only get the cashless facility while getting treatment at a network hospital. The hospital’s TPA (third-party administrator) team will contact the insurance company and send a pre-authorization form to initiate the claim settlement process. The steps are explained below-
- Provide the insurance card and ID proof to the hospital authorities at the insurance desk.
- Fill out the cashless claim form and submit the required documents at the hospital. To expedite the process, it’ll also be better to inform the health insurance provider.
- The insurance provider will review the application and documents submitted by the hospital and provide confirmation via SMS or email.
The hospital bills will be settled before the discharge as per the terms and conditions of the insurance policy.
Reimbursement Claim Process
With a reimbursement claim, the patient needs to pay the treatment expenses upfront and later on request to get reimbursement from the insurance provider. Unlike a cashless facility, the reimbursement claim is handled by the patient without much assistance from the hospital authorities.
Follow the steps below to get a reimbursement claim-
- Inform the insurance provider regarding the hospitalization within 48 hours of being admitted.
- Make the payment directly to the hospital.
- Obtain the claim form from the insurance agent or online and fill in the details.
- Provide the required documents and submit the form within 30 days of discharge.
- The insurance company will review the documents, and when approved, the amount paid at the hospital will be credited to the patient’s account.
Note: There is a standard condition that the patient needs to meet, i.e., hospitalization for 24 hours to file a claim.
