Do you need the insurer’s approval for each chemotherapy session?

Do you need the insurer’s approval for each chemotherapy session?

My mother had to undergo chemotherapy and she needed 6-8 sessions as advised by the doctor. Finding approval for insurance coverage every time my mother went through therapy was a hassle. What can I do to avoid return approvals?

—Name withheld by request

In some cases, insurers may require approval for the overall treatment plan rather than for each individual session. Once they agree to the initial treatment plan, you may not need to get additional approvals for follow-up sessions at the same hospital. Also, there are some insurers that provide an approval for all sessions at the beginning of treatment if the treatment takes place in the same hospital according to the advice of doctors. But just to be on the safer side, it’s a good idea to check with your insurer.

Some insurers may require pre-authorization for each chemotherapy session. This process involves submitting the necessary documents, including the treatment plan, medical reports, and other relevant information, to the insurer for review and approval. It is important to follow the process according to the insurer’s guidelines.

Regardless of the approval process, it’s important to maintain open communication with your health insurer. Inform them about the prescribed number of chemotherapy sessions and ensure the prompt provision of any necessary documentation as soon as possible to expedite coverage and prevent possible payment delays.

Familiarize yourself with the scope of coverage and limits set by your insurance company regarding chemotherapy treatment. Make sure that the number of sessions recommended by the doctor is within the coverage limits specified in the policy. If there are any limitations, discuss potential alternatives with the insurer. Also, there may be some exclusions for the treatment method, which will vary depending on the insurer.

If there are any changes or adjustments to the treatment plan during chemotherapy, such as a change in medication or dosage, you must notify your insurer immediately. This allows the insurer to evaluate the changes and determine the need for further approval.

In the case of an emergency where immediate chemotherapy is required, seeking pre-approval may not be possible. In such instances, notify the insurer as soon as possible to ensure a problem-free payment process.

Throughout the treatment process, it is important to keep the insurer informed about the progress of the chemotherapy sessions. This may include sharing medical reports, updates from the treating physician, and any changes to the treatment plan.

It is important to note that every insurance policy is designed according to the profile of the insured and therefore it is advised to check the terms and conditions of your policy carefully. Talk to the insurer, and maintain open communication to ensure that your mother’s treatment is properly covered and that the claims process is smooth and trouble-free.

Parthanil Ghosh is president-retail business, HDFC ERGO.

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Published: 25 Jan 2024, 10:43 PM IST

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