Is Pre-authorisation Required for Cashless Hospitalisation?

Yes, in India, pre-authorisation is a key step to unlock seamless and hassle-free claims for expensive medical treatments. Imagine you are driving home and suddenly feel chest pain, leading to hospital treatment and looming bills.

Enjoy policy coverage as your medical insurance promises cashless hospitalisation. But is pre-authorisation mandatory for availing cashless hospitalisation?

Do You Need Pre-authorisation for Cashless Hospitalisation?

Yes, pre-authorisation is required for cashless hospitalisation. Pre-authorisation is evidence that you have obtained initial approval from your insurer for any medical procedure or treatment. Once the hospital where you are admitted receives pre-authorisation from your insurance provider, they will start your treatment.

Once you get approval, you are admitted to the hospital, and treatment will begin. In case the treatment cannot wait for pre-approval, the hospital asks for an initial deposit, but this is only for emergency cases.

How Initial Approval or Pre-authorisation Works for Cashless Hospitalisation?

1. Purpose of Pre-authorisation

Initial approval ensures that any treatment complies with your policy terms and conditions. It reflects that your insurer has preliminarily agreed to cover the entire cost of your hospitalisation and treatment, subject to further verification.

2. The Verification Process

This verification is crucial to eliminate any chance of claim delay, future discrepancies, or rejections during final approval. It involves submitting a pre-authorisation form with valuable information to the hospital, and then starting the verification process. The pre-authorisation form contains:

• Policyholder's name


• Diagnosis details


• Suggested treatment details


• Health insurance policy number


• Estimated cost of hospital stay and treatment

It also tracks health details, including medical care history, and other relevant documentation.

3. Conditional approval

Once your details are in, your insurer issues initial approval, allowing the hospital to process cashless treatment. This allows the hospital to start the medical procedure without billing any upfront costs, aside from non-covered charges.

How Can You Access Cashless Health Insurance?

When you require medical care, especially for a planned procedure, admit to a network hospital and take advantage of cashless treatment.

● Planned Hospitalisation

You can take admission to any network hospital near your location for any planned treatment or prescribed procedure. Provide the required documents and policy details, and the hospital will send details to your insurer. After reviewing all documents and policy details, your insurer can approve the claim, and you will get cashless treatment.

● Emergency Hospitalisation

Submit policy details to the network hospital, and this hospital authority will send the necessary documents to your insurer in the event of an unexpected medical emergency. If approved, the hospital can start cashless treatment.

● Pre-authorisation

This involves filling out the pre-authorisation form with treatment details and submitting it to the insurance company to complete the approval process.

● Submit Documents and Let the Hospital Handle

Provide all necessary documents, including an ID card, health card and all your medical records, to make the claim process hassle-free. The network hospital directly deals with the insurer to reimburse the treatment cost.

Final Statement

The hospital insurance desk can definitely help you with the pre-approval documentation process. After reviewing the details, your insurer can approve the claim. Most insurers approve cashless claims within 2 hours or within a few days after paperwork.