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Process of mediclaim if we subsequently move from One hospital to another hospital?

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29 Sep, 2023 by  prafulla sangle

how cashless mediclaim process works if we have to move from one hospital to second hospital for treatment of same ongoing disease due to lack of some facilities in First hospital?

Health Insurance

1 Answer

03 Oct, 2023

Hello Prafulla,

In such a situation, it's important to understand that it involves two separate claims, and there are two possible scenarios to consider -

  1. Scenario 1: Cashless has been applied at the first hospital, and a pre-authorization has been approved. The patient's treatment is started there, but suddenly their condition worsens within say 3-4 hours, and it's recommended that you should be transferred to a higher-level medical facility. Now, depending on the bill amount incurred at the first hospital up to that point, there's an option to cancel the cashless claim there. In this case, you may need to pay the expenses incurred at the first hospital from your pocket and apply for reimbursement. After that, a new cashless claim must be initiated at the second hospital to cover the ongoing treatment.
  2. Scenario 2: You're at the first hospital with cashless and pre-authorization in place. Treatment has begun, but after say 1-2 days, the patient's condition worsens and and a transfer to a higher-level medical center is deemed necessary. In this case, the cashless process at the first hospital continues as planned. Any expenses incurred there are covered according to the policy T&Cs. Once the patient is transferred to the second hospital, a new cashless claim must be initiated to cover the ongoing treatment.

I hope this clarifies. Thank you!

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