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Need information about cashless claim when Base and SuperTop up policis are from different companies

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07 Nov, 2021 by  Rayapu Ashok Kumar Reddy

Dear Members


I need information on cashless claim when base and supertop up polices are from differnent companies.

I enquired with some of the health insurance companies they said that they can provide super top up cashless when they get settlement letter from the first insurer.

So, how long does it take the company to issue settelemnt letter now a days with the advancement of technolony. Will the company issue settlement letter immediately after the sum insured exausted and if we provide relevant documnets immediately?


Is it really possible to claim for cashless claim when two policies are from different companies

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10 Nov, 2021

Hi Ashok,


To answer your question simply, Yes it is possible to get a cashless claim settled when 2 policies are from different insurers.


However, it will be time consuming.


The usual (max)TAT for any company to send a final approval for a cashless claim is around 4 hours from the time that all required documents (All queries if any are resolved) are submitted. So when claiming from 2 different insurers that TAT become 8 hours.


Having said that, 4 hours is the Max TAT and usually an approval is given in around 2 hours by most insurance companies.


The second insurer from whom you will claim the balance amount will require the final approval letter from the first insurer along with the bills and documents which were not passed by the first insurer.


TPA desks at most renowned hospitals are aware of the procedures regarding claiming from 2 different hospitals. However smaller hospitals may not be well versed. It is advised that you approach the TPA desk of the hospital well in advance and brief them about the situation and your requirement and get them to agree to help you out. (Ideally they are suppose to but some hospitals might create issues). Without the support of the hospital TPA it will very difficult to execute this.


Hope this helps!


Cheers :)

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13 Nov, 2021

Dear Ashok

In practice , insurer follow same process as advised by Expert Kiran .

However , the contract does not mention that . . Insurance company only want a confirmation that deductible amount has been paid and exhausted . This can be paid through own fund or insurance company of base plan .

It is necessary that we establish the use of deductible amount and cashless claim has to be given by super Top up insurer .

Hope this clarifies


Shailesh@insurancesamadhan.com

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