Health insurance has its complications in India and might overwhelm the average person if unprepared. One such document that can ease the process is the Pre-Authorization Form or Pre-Auth Form. If your insurance is handled by Medi Assist, then clarity on how to fill and submit the Pre-Auth Form will make the difference. It helps to understand the timely approval of cashless treatment and waiting in limbo for days.
Here, we bring to you everything about the Medi Assist pre auth form, what it is, a step-by-step method of filling it out, the usual mistakes to avoid, and some FAQs.
What Is a Pre-Authorization (Pre Auth) in Health Insurance?
A Pre-Authorization or Pre Auth in health insurance is an official request sent to the insurance company for approval of any medical procedure or hospitalization beforehand. It is usually required when the insured person opts for a process that is cashless in one of the network hospitals.
In case of planned hospitalisations or surgeries of policyholders, the hospital forwards the Pre Auth request to the insurer on behalf of the patient. Along with the request are details of the relevant medical information, diagnosis, estimated costs, and recommendations of the doctors. The insurer studies the submitted information and then determines the acceptability of the treatment as per the terms of coverage of the policy.
Key Benefits of Pre-Authorization:
Cashless facility for treatment in network hospitals.
Guarantee of coverage before the commencement of the procedure.
Decreases out-of-pocket payment during hospitalisation.
Increases claim approval and hospital discharge.
In case of no pre-authorisation, the holders may have to pay upfront for treatment, which may prove financially stressful during medical emergencies.
What Is the Medi Assist Pre Auth Form?
Medi Assist stands tall as one of the premier Third third-party administrators in India. It serves as the value addition between insurers, hospitals, and policyholders. If your health insurance is under Medi Assist, any planned hospitalization recognized at a network hospital requires submission of the Medi Assist Pre Auth Form.
This is an important form to:
- Start the process of a cashless claim.
- Let Medi Assist know what treatment is planned, the diagnosis, and the estimated cost.
- Enable Medi Assist in deciding on eligibility, scrutinising the policy details, and proceeding with claim approval.
Typically, the hospital’s insurance help desk fills out the Medi Assist TPA Pre Auth Form, but patients and caregivers should still be aware of what’s being submitted.
Step-by-Step: How to Fill the Medi Assist Pre Auth Form
In general, the Pre Auth Form is split into two parts.
- First Part (To be filled by the Policyholder/Patient)
- Second Part (To be filled by the Treating Doctor/Hospital)
Let’s walk through each section:
Part A: Details by the Policyholder
Patient Name and Contact Details
- Ensuring your spelling harmonizes with the ID as well as the insurance policy.
- A phone number must be reachable for a call; an email must be sent to the same effect.
Policy Number & Health Card ID
- Have the policy number and card number of Medi Assist.
- If unsure, contact Medi Assist or download the Medi Assist Pre Auth Form PDF from their official portal.
Relation to Policyholder
- Mention the relationship: self, husband, wife, son, daughter, etc.
Hospital Details
- The name of the hospital and address should be written.
- Make sure it is listed as a Medi Assist empanelled hospital.
Type of Hospitalization
- Tick: Planned/Emergency.
Date and Time of Admission
- Mention the expected date for admission and surgery.
History of Present Illness
- Briefly say what the symptoms were and when they began.
Part B: Details from Hospital/Doctor
Diagnosis/Treatment Plan
- It must be filled up and signed by the treating physician.
- ICD codes, procedure details, and treatment rationale included.
Estimated Cost of Hospitalization
- Detailed breakup: room charges, doctor’s fees, investigations, medicines, OT charges, etc.
Duration of Stay
- The expected number of days stay is specified.
Pre-existing Conditions
- The hospital to declare any past medical conditions.
Doctor’s Declaration
- Signed and stamped by the treating doctor.
Hospital Declaration
- Signed by hospital administrator or an insurance desk representative.
For added convenience, you can get the Medi Assist Pre Auth Form Download from the Medi Assist website.
Common Mistakes to Avoid When Submitting the Pre Auth Form
Filling errors can lead to delays or denial of your Medi Assist Cashless Pre Auth Form. Here’s what to avoid:
Incomplete Information
One of the top reasons for delay is not having full patient or policy details. Always cross-check that every field is duly filled.
Incorrect Policy Number or ID
Before submission, cross-verify that the policy number and Medi Assist card ID match. A mismatch leads to outright rejection.
Lack of Medical Grounds
If the diagnosis or recommended treatment is ill-documented by the doctor, Medi Assist may reject the claim or seek clarification.
Lateness of Submission
For a planned admission, Pre Auth should ideally be submitted at least 3-5 days prior. In case of an emergency, it must be filed within 24 hours of admission.
Wrong TPA Submission: Legitimate Concern to
Double-check that you are indeed submitting to Medi Assist and not any other TPA (where applicable). Generally, the division at the hospital where billing for insurance is handled should have that information, but it is better to confirm.
No Signature or Stamp
The form needs to have signatures by the hospital and the treating doctor, with the hospital’s official stamp affixed on it. Absence renders the request void.
Why the Medi Assist Pre Auth Form Matters
Understanding and properly using the Medi Assist Insurance Pre Auth Form brings several benefits:
- Quicker Claim Approvals: When the supplied information is truthful, decisions are made faster.
- Financial Planning: You are made aware in advance about what will be covered and what will not.
- Less Paperwork at Discharge: There is less delay at the release of the hospital with cashless approval.
- Peace of Mind: During health crises, claim disputes, or reimbursement hiccups are the last things you want to face.
Whether it’s the MediAssist New Pre Auth Form or an updated digital version, knowing how to fill it can make or break your healthcare experience.
Frequently Asked Questions (FAQ’s)
1. Is Pre Auth approval guaranteed by Medi Assist?
No. Approval is given based on policy terms, coverage limits, and medical necessity. Medi Assist approves unit review.
2. How long does it take for Medi Assist to get a Pre Auth request processed?
For non-emergency treatments, it usually takes anywhere between 6 to 24 hours for Pre Auth approval to be given. In emergencies, it is granted sooner, usually within a few hours.
3. Can I fill this form myself?
The Patient or the Caregiver can fill up Part A of the form, but Part B is to be filled in by the hospital and the doctor.
4. What happens if Medi Assist decides to reject the Pre Auth?
You can pay upfront and apply for reimbursement later, or you can appeal with further medical documents.
5. Do I have to submit original documents during the Pre Auth?
Generally, a scanner or photocopies of documents are accepted for Pre Auth. Originals are required at the time of final claim settlement.