Last Updated on December 18, 2021 at 10:50 pm
In March this year I had a thymectomy – surgery to remove my thymus gland. The procedure was paid via cashless mediclaim. I thought sharing my experience with ‘cashless’ might be useful to other readers.
My hospitalization was planned. That is I had plenty of time (5-6 weeks) to plan my hospital stay from the moment it was decided to go ahead with the surgery. Sometimes one has only a few days depending on the procedure. Even for such cases the patient and his/her attendant have the time to get all insurance particulars in order, approach the hospital and get the stay approved by the insurer for cashless payment via the hospital.
Cashless claim for emergency hospitalization is a different ball game. In this case the patient can do nothing to help with the paperwork and procedures. To avail cashless mediclaim, the insurance particulars have to be located. This may not always be possible (road accidents, hiking accidents and sometimes even in the office or home). Cashless mode cannot be relied upon for emergencies.
Once I made up my mind about the surgery and the family agreed on a date, I approached the insurance department of the hospital and obtained a cashless pre-authorization form. I also found out the room tariffs and the approximate cost of the procedure.
🔥Secure your future with our Robo-advisory tool trusted by over 3,500 investors and advisors. From effortless retirement planning to funding your children’s biggest dreams, turn your financial goals into reality. 🔥
Subscribe for money management solutions via email! (Link takes you to our email sign-up form) Join 32,000+ readers in our community.
👉 New Tool Alert! NaviPlan: A Privacy-Focused Multi-asset Tracker and Goal Planner 👈
Thymectomies are relatively less common procedures. So I was given a ball park estimate of costs. Next I went to the surgeon and asked him to fill out the form and sign it. My policy has sub-limits on room rent (1% of the sum insured) and ICU rent (2% of SI). Since I had increased the sum insured each year for the last 5 years, I could afford the deluxe room which was more than comfortable for me and my brother-in-law who stayed with me (regular readers will know that this is not the first time he has helped me. He is a fantastic guy).
The insurance department wanted me to report with the pre-authorization form, PAN card copy, insurance policy copy and all relevant medical records two days before the surgery. In case the cashless claim was not approved, I moved around my emergency funds so that I have enough cash ready.
When I went to submit my application, I was interviewed by a doctor who is employed full time in the insurance department. I learnt something very important from her. My current SI is Rs. 5 Lakhs. When I was diagnosed with Myasthenia Gravis (the reason I needed the thymectomy), my cover was Rs. 4.5 Lakhs. This means that for the next two years (according to my policy) any hospitalization arising from Myasthenia will have a limit of Rs. 4.5 Lakhs and not Rs. 5 Lakhs. It is treated as a pre-existing disease and the rules that applied when the policy started also apply here!
This is a very important reason why we should increase the SI as much as possible for all family members each year. If I had left my initial SI of Rs. 1 Lakhs unchanged, my cashless application would have been rejected. The doctor in the insurance department reviewed my medical records and was satisfied that everything was in order.
I was told that my application would be forward to the TPA (third party administrator) and that it will take 8-12 hours for a response. I called back the next day and found that my application was accepted and that the TPA had approved about 50-60% of the expected total cost initially. Since I was getting admitted on a Sunday, I made sure that the insurance department would be open that day!
When I got admitted, the reception checked with the insurance department and my admission was approved. I had to pay a small fee for registration. I was in hospital for 3 nights. Thanks to an extremely competent doctor and support staff, my stay was quite pleasant!
Although the medicines and other costs were covered under the cashless scheme, we still had to pay a few thousands for miscellaneous items like gloves certain types of dressing material etc. So it is important to keep cash/card ready all the time.
Discharge after a cashless hospital stay can be time consuming. The discharge summary and all other records go to the insurance department to be forwarded to the TPA. The TPA takes a few hours to approve the remaining cost of the surgery and clear the discharge. If there is an issue (there wasn’t in my case) then we will have to be prepared for a delay and if necessary shell out some cash. This can later be claimed via reimbursement.
In my case, the actual cost was lower than the estimate the hospital gave. Probably why the discharge went smooth! Probably why the hospital is part of the preferred network hospital of the TPA!
Of course choosing the doctor is more important than choosing the hospital. If a competent doctor works in a non-network hospital we must be ready to pay for hospital expenses and later apply for reimbursement.
My doctor does about 4 heart surgeries a day. He could have cut me open across my ribs, removed my thymus in 45 minutes and moved on to the next operation. Instead,he chose a minimally invasive procedure with 3 holes on the side of my chest. The operation lasted (I am told) more than two hours. The 45 minute operation meant 2-3 weeks recovery. The two hour operation meant a recovery of 2-3 days! Thanks to him, I practically had no pain!
Policy: United India Platinum Cover (individual covers for each member)
TPA: TTK HealthCare.
Although I am quite happy with the policy, I must admit that when I purchased it I knew nothing about such policies and personal finance.
What are your views on cashless mediclaim?
We are on Google News
Use this button to add freefincal.com as a preferred personal finance source on Google News.
Explore 1,400+ videos on YouTube!
Subscribe to get posts via email!
Join 32,000+ readers and get free money management solutions delivered to your inbox! (Link takes you to our email sign-up form)Join our WhatsApp Channel
Explore our products
🔥Join our community of 9000+ users! 🔥- Use our Robo-advisory Tool to create a complete financial plan! More than 3,500 investors and advisors use this! Use the discount code robo25 for 20% off. Plan your retirement (early, normal, before, and after), plus non-recurring financial goals (such as child education) and recurring financial goals (such as holidays and appliance purchases). The tool helps anyone aged 18 to 80 plan for retirement, plus six non-recurring and four recurring financial goals, with a detailed cash flow summary.
- Our Flagship Course! Learn to manage your portfolio like a pro to achieve your goals regardless of market conditions! More than 3,500 investors and advisors are part of our exclusive community! Get clarity on how to plan for your goals and achieve the necessary corpus no matter the market conditions! Watch the first lecture for free! One-time payment! No recurring fees! Lifelong access to videos! Reduce fear, uncertainty and doubt while investing! Learn how to plan for your goals before and after retirement with confidence.
- Join the freefincal investor circle! An exclusive space for investors, advisors, fintech employees and students to access financial planning and insurance tools, mutual fund and stock analysis tools, coding strategies and Excel macros for data extraction. 750+ members are now part of our investor circle.
- Increase your income by getting people to pay for your skills! More than 900 salaried employees, entrepreneurs and financial advisors are part of our exclusive community! Learn how to get people to pay for your skills! Whether you are a professional or small business owner seeking more clients through online visibility, or a salaried individual looking for side or passive income, we will show you how to do it by showcasing your skills and building a community that trusts and pays you. (Watch the 1st lecture for free). One-time payment! No recurring fees! Lifelong access to videos!
- Portfolio Tracker! Track your mutual funds and stock investments with our Google Sheet!
- We also publish monthly screeners for
Our Podcast: Let's Get Rich With Pattu
On Spotify: Let's Get RICH With PATTU! Every single Indian CAN grow their wealth! On Audible: Listen to the Let's Get Rich with Pattu Podcast
Listen to the Let's Get Rich With Pattu podcast on YouTube.
Now watch Let's Get Rich With Pattu தமிழில் (in Tamil)!About The Author
Dr M Pattabiraman giving a lecture
- Dr M. Pattabiraman (PhD) is the founder, managing editor and primary author of freefincal. He is an associate professor at the Indian Institute of Technology, Madras.
- He has over 14 years of experience publishing news analysis, research and financial product development. He has over 28 years of teaching and research experience. He is also a public speaker and keynote presenter.
- He is a patron and co-founder of “Fee-only India,” an organisation promoting unbiased, commission-free, AUM-independent investment advice.
- Connect with him via @pattufreefincal on X LinkedIn YouTube
- Pattabiraman has co-authored three print books.
This book helps you ask the right questions and find the right answers. It also includes nine online calculators to create custom solutions.
(2) Gamechanger: Forget Startups, Join Corporate & Still Live the Rich Life You Want. 
Both the boy and girl versions of "Chinchu Gets a Superpower".
Most investor problems stem from a lack of poor decision-making. We made bad decisions and money mistakes when we started earning, and we spent years undoing them. Why should our children go through the same pain? What is this book about? As parents, what if we had to groom one ability in our children that matters not only for money management and investing but for every aspect of life? My answer: Sound decision-making. So, in this book, we meet Chinchu, who is about to turn 10. The story follows what he wants for his birthday and how his parents plan it, while also teaching him key ideas about decision-making and money management. What readers say! 
Feedback from a young reader after reading Chinchu Gets a Superpower!
Must-read book even for adults! This is something that every parent should teach their kids right from a young age. The importance of money management and decision-making based on their wants and needs. Very nicely written in simple terms. - Arun.
About freefincal & its content policy
Freefincal is a News Media organisation dedicated to providing original analysis, reports, reviews and insights on mutual funds, stocks, investing, retirement and personal finance developments. We do so without conflict of interest and bias. Follow us on Google News. Freefincal serves more than three million readers a year (5 million page views) with articles based only on factual information and detailed analysis by its authors. All statements made will be verified with credible and knowledgeable sources before publication. Freefincal does not publish paid articles, promotions, PR, satire or opinions without data. All opinions will be inferences backed by verifiable, reproducible evidence/data. Contact Information: To get in touch, please use our contact form. (Sponsored posts or paid collaborations will not be entertained.)Our publications
- Your Ultimate Guide to Travel. This is an in-depth exploration of vacation planning, including how to find affordable flights, budget accommodations, and practical travel tips. It also examines the benefits of travelling slowly, both financially and psychologically, with links to relevant web pages and guidance at every step. Get the PDF for Rs 300 (instant download)
- How to profit from content writing: Our ebook is for those interested in getting a side income via content writing. It is available at a 50% discount for Rs. 500 only!