Insurance Claim Process For ICL Surgery
The health insurance claim process can be classified into two types. These include cashless claims and reimbursement claims. The process for each method differs and is described below:
Cashless claim
This type of claim does not require payment upfront, as the insurance company takes care of it for you. However, in order to avail of the benefits of a cashless claim, you have to avail of treatment at a network hospital, a hospital that is on the list of empaneled hospitals of the insurance company.
Cashless claims can be filed for planned and emergency medical treatments. For a scheduled surgery, you need to visit the hospital two days before the hospitalization and complete the required formalities. For an unplanned hospitalization, you need to visit the cashless counter within 24 hours of admission and complete the required formalities.
Once a cashless claim has been filed, your insurance company will send an authorization letter to the hospital after verifying your eligibility for the submitted claim.
Reimbursement claim
With a reimbursement claim, the payment for the surgery has to be made upfront before the claim is filed with the insurance company. This is applicable when the patient has received treatment at an out-of-network hospital. The claim process involves submitting the required documents along with the claim form to the insurance provider within 30 days of your discharge. The required documents include the claim form, medical certificate, diagnosis reports, ID proof, discharge summary, and all relevant prescriptions and bills.
If the reimbursement claim is not filed within the given deadline, the insurance provider can reject the claim, citing technical grounds.
Health Saving Plans For ICL Surgery
Patients can consider purchasing specific health plans that can partially cover the cost of elective procedures such as ICL surgery. These health plans can be beneficial in the long run as they can also cover the costs of regular eye exams and other diagnostic tests. These are known as Health Saving Plans. They differ from traditional insurance plans in that they offer health insurance coverage as well as savings to cover the costs of future medical expenses.
The table below highlights the main differences between a health savings plan and traditional health insurance:
|
Health Insurance Plan
|
Health Savings Plan
|
|
Benefits
|
The entire amount is used for insurance coverage.
|
30–40% of the amount is put in a savings account; the remaining is used for insurance.
|
|
Coverage
|
Full coverage
|
Partial coverage
|
|
Insurance premiums
|
Comparatively high
|
Comparatively low
|
