In which event(s) does availing cashless facility not require a pre-authorisation from the insurer/TPA?

Solution(By Examveda Team)

A third-party administrator (TPA) is an organization that processes insurance claims or certain aspects of employee benefit plans for a separate entity.
Reimbursement of the hospitalization expenses can be claimed where cashless hospitalization facility is not availed or treatment is availed in a non-network hospital. In that case the pre-authorisation is not required. The customer would need to settle the bills at the hospital and submit the documentation in attestation within 30 days from the date of discharge.
In case of emergencies, cashless facility does not require pre-authorisation for the conduct of treatment in a hospital. After the patient is admitted, the hospital fax the pre-authorisation to the TPA.