Diabetic Retinopathy Treatment Under Insurance- 100% Cashless

How to Get a Health Insurance Claim for Diabetic Retinopathy Treatment?

The policyholder can claim health insurance in two ways- cashless and claim. The process to file an insurance claim is explained below in detail. 

Cashless Claim 

This type of claim can only be filed by the policyholder while seeking treatment at a network hospital of the insurance company. 

• Intimate the insurance provider about the treatment. 
• Provide the insurance ID or card at the hospital’s TPA (third-party administrator) desk 2-5 days prior to the surgery. 
• The TPA will provide the cashless claim form that the patient needs to fill and sign. Submit the form at the TPA desk. 
• The TPA team will further inform the insurance company, submit the claim form, and provide the necessary medical records. 
• The insurance company will validate the documents and provide approval of an amount that is viable. The co-pay clause and/or claim limitation may be applicable for the treatment, due to which there may be restrictions over the amount that can be claimed. 
• The patient will receive the approval through an email or text message. 

The hospital bills will be settled directly between the insurance company and the hospital. If the claim is denied, the patient will be intimated about the same and can file a reimbursement claim request. 

Reimbursement Claim 

The reimbursement insurance claim allows the patient to get compensation for the amount of money already paid during the treatment. This type of claim is availed by the patients while seeking treatment at a non-empanelled hospital of the insurance company. 

• Inform the insurance company about the treatment within 48 hours of hospitalization. 
• Get the reimbursement claim form and submit it within 30 days of discharge from the hospital. 
• Submit original copies of all medical reports, bills, discharge summary, prescriptions, etc., with the claim form. 
• The insurance company will verify the documents and issue a cheque in the policyholder’s name. In some claims, the amount is credited to the policyholder’s bank account. 

The reimbursement claim may take around 14 to 21 days to settle. If the patient delays filing the claim 30 days after the surgery, the insurer won’t be liable to provide any compensation for the treatment. 

Expenses Covered by Health Insurance

Various expenses that are generally covered by health insurance policies include the following- 

• The doctor’s consultation and operating fee 
• Anesthesia and anesthetist fee 
• Hospital admission and discharge fee 
• OT and ICU charge 
• Nursing fee
• Room rent (single, double, or sharing) on a daily basis
• Medicines and IVs given to the patient during hospitalization 
• Medical consumables, including syringes, sutures, catheters, gloves, masks, dressings, etc. 
• Post-surgery follow-up consultations 

The patients can also choose add-on coverage to further extend the coverage of the insurance policy. Each policy can be customized according to the patient’s needs. The patients can also get pre-existing disease coverage by paying higher premiums.