Ego Problem

1. If possible cashless procedure should be initiated 1 day before hospitalization.
2. Hospitals are not taking risk because the possibility of rejecting the claims by insurance co. even after approval for the cashless.
3. Irritation of the employee is obvious looking at the situation at the hospital.
4. Apologising doesn't mean that YOU are wrong & the other is right, it only means that YOU value the relationship much more than your EGO.
Bear in mind that, If the path is beautiful, let's not ask where it leads. But if the destination is beautiful, let's not ask how the path is.
Regard.
Khedkar Prafulla

Hi,

Kalpana has ritely said that the detailed procedure to claim the benefits of mediclaim will be given by the insurance company or the broker from where the mediclaim group policy is taken.

Sharing certain details about the mediclaim procedure as below:

1. Mediclaim policy covers self, spouse, dependent children (max 2) and dependent parents (does not cover in laws even if the employee is a married woman).

2. Cashless Benefits - Intimation is required to be sent to the HR and HR in turn will inform the insurance co. or broker about the same. There will be two types of Hospitalization - a) Planned Hospitalization & b) Unplanned Hospitalization

Planned hospitalization - The required cashless form to be filled in advance, to be given to the insurance company or broker, they in turn will forward to TPA (Third Party Administrator) for approval, approval will depend upon the kind of hospitalization, limit as mentioned in the policy, etc..

An approval shall be received from TPA, the same shud be then produced to the hospital while getting admitted

Unplanned / Emergency Hospitalization - Employee here can take help of HR, and HR can inform this to the Insurance co / broker about the hospitalization. Cashless Claim form is available at the network hospitals, employee will fill the same and proceed as mentioned above.

3. Reimbursements - In case of reimbursements, employee bears the cost of hospitalization and then gets the same reimbursed by producing the original bills of hospitals, including the admission and discharge card. Employee has to maintain all the bills in original in order to get an hassle free reimbursement. The documents has to be submitted to the TPA / Broker within stipulated time period as mentioned by them in the policy.

4. Health Cards are given to each and every employee once the policy is taken / renewed. In case if employee loses the card, the same can be availed in a duplicate form from the Insurance Co / Broker.

5. Online facility is also provided by the insurance co.. wherein HR can have a daily check on the site finding the details of claim registered, status of claims paid / pending / rejected / in query / etc...and can also get a copy of Health Card.

Any other query, please feel free to ask.

Regards,

Smita

hi Prema,
The first step towards sensitive HR is the empathy. The time she was in need she was searching for some help so calling u time and again, but once she was confirmed that she had to pay for time being she stopped calling, might be for not disturbing u any more. I would not preach the absolute generosity, but we have to develop the endurance to certain kind of variety in behaviour, especially the errant behaviour under stress. Secondly, we again need to see that is the formality of informing is a real necessicity or just to passify the self concept of HR people. If the case is second one than we should remove the hurdles and formalities and make the process self flowing. However, u are the only best judge of what transpired between you two. But in any case, let not the mind be distracted by the insignificant things and continue for the broader goals of HR.
Regards,
ds

Hi Prema
Never feel that employee should convey to you.
they may be in such a situation that it cannot be possible for them to convey it to you. As a matter of fact you could have send some of your assistant to attend the patient and keep them feel comfortable.
Cheer up and get fresh and proceed your journey towards service to all (Paropakarena idham sareeram)
Okay

Mediclaim is cashless (in case of an empaneled hospital) or the money spent on the treatment can be re-imbursed as pointed out by Mr Sriram Warrier. In case of reimbursemment, the documents in ORIGINAL to be submitted to the Ins Co. The documents are:

1. Discharge Summary

2. The bills - including surgery, treatments, post and pre procedures (like X-Ray, CAT Scan etc), medication etc.

3. The patient's ward reports during the stay in the hospital - like the visit from the Dr / Nurse hourly to the patient during the admission etc. This report is retained by the hospital - you can otain a photocopy of this report duly authenticated by the Head of the hospital / Director.

4. The original reports of EGC, Lab Tests, CAT Scan, X-Ray etc. You can requested the Ins Co to return these documents for further referance.

5. A Clinical report visit to the Dr pre and post admission - where the doctor precribes the medicine, change of medicine (if any) etc. Most Ins Cos reimburse the cost of the out-patient post-admission charges for 60 days.

6. The claim form.

ALL the above should be authencated by the Hospital. The above in my expecience with Medi Calm and I can say that 90% of the claim was settled within 15 working days. (We have the ins with Bajaj Alliance where there is no TPA!)

Raju Siachen

Hi,
Based on her information only you have helped for cashless treatment. Hence there is no need for separate information for reimbursement. Information may be either from the employee or colleague, it must be accepted on humanitarian grounds.

Dear Prema
Medical attendance and medical assistance (particularly hospitalization) are the matter of emergency and distress. How your company frame such a policy the advance information is required for the same. It is ridiculous. Rather you should assist the employee in this regard.
However, it is the duty of the Hospital too in case of cashless claim, if the patient announces that he has a mediclaim cover, to inform the Mediclam that such case is with them. But while in distress sometimes this aspect is ignored or overlooked.

Dear Prerna,
Don't leave it as such; A employee is a asset to the company don't do such acts so that organisation may loose its asset appropriate resolution would be ask the employee to send unfit certificate attested by the doctor mentioning the reason that at that time S/he is not able to intimate due to his/her critical stage...It will work anyways policies are make by human not human is made by policy.
Have a Great time!!!

Dear Ms. Prema,
This is the issue about the SYSTEMS & PROCEDURES but not EGO. I would suggest that, there is also COMMUNICATION GAP. Please don't expect employees to be 100% perfect when they are facing issues related to MEDICAL as it concerned with LIFE & DEATH.
Please help your employee and cooperate with them so that they get best support from the company and treatment as well.
If you support them today, one fine day you will be supported divinely and company will also be benefitted. Anyways, neither you nor company is going to loose. Please extend your cooperation at the maximum level.
With profound regards

Rightly said Mr.Khadir
We must support those really who is in inneed.
The timely help will obviously be recognised by everybody, including your rivals.
You can even extend your help out of way too.