1. In case of any doubt in the coverage of treatment pertaining to the present ailment under the Policy
2. if the information sent to TPA is insufficient to confirm coverage.
3. If the ailment/condition is not being covered under the policy.
4. If the request for pre-authorization is not received by TPA in time. In such a situation, the Insured can take the treatment, pay for the treatment at the hospital and upon being discharge, send the claim to TPA for processing.
5. In case the hospital in not on the panel of the company
6. The disease/illness is pre-existing and still in waiting period.
What are the situations under which one may be denied cashless hospitalization?
