Insurance for procedures

Insurance for procedures in gastroenterology

When you have a digestive symptom that has been there long enough to cause concern, you may be advised some tests to look for what could have caused it, and what would need to be done to guide treatment.

Your symptom may be serious enough to hamper your day-to-day life; thus you may prefer to seek admission into a hospital. Investigating you in hospital hastens the time in which your doctor could reach a conclusion about how to treat you further. Once the cause of your problem has been diagnosed, treatment could start and you would be fit for continuing treatment from home.

If you wish to seek the benefit from your insurance policy, your doctor will need to fill a prescribed TPA form; giving a plan about what the tentative diagnosis is, what is the proposed line of investigations & treatment; and the costs for the same. On your part, you will need to give your preference of which hospital accommodation you prefer. The hospital will fill into the form, the approximate daily costs for stay, food and other incidentals. It takes 4-6 hours for the insurance TPA to reply by fax, whether your claim will be settled by them.  The hospital Insurance Desk will then advise you admission for further treatment.

Through your stay, the hospital & your doctor are constantly in touch with the Insurance TPA; keeping them up-to-date with the progress of your recovery. Your Insurance company needs to be satisfied that
  • the cause of your symptoms was serious enough to need indoor treatment,
  • investigations done were adequate (not too many, or too few)
  • the diagnosis and treatment were accurate, conclusive & appropriate and,
  • Possibly you will not need to repeat the claim.
A day before the tentative discharge, all records are sent to your Insurance TPA. It could take the full working day to get a reply that your claim has been settled. Only then you could be discharged. Thus your doctor will try to process your papers a day before your tentative discharge.

On the other hand, your symptoms may not be serious enough to need admission to the hospital. Often, you may just need an upper endoscopy (gastroscopy), lower endoscopy (colonoscopy); or imaging procedures like an ultrasound or a CT scan. These are Office, or Day-care procedures; thus are not eligible for Insurance claim. We advise you not to seek admission just for 24 hours, just so that you could claim benefit from you Policy; often, such claims are disallowed even after you 24 hour stay; thus obliging you to pay for the procedure as well as the stay.

For more information about Insurance related issues, you could speak to the following desks at your hospitals.