How to get post-facto sanction for paid medical bills?

Dear Anjana Banerjee ji,

A 'post facto sanction' refers to a retrospective approval for medical expenses that have already been incurred and paid for, often sought when a pre-authorization was not obtained or a cashless facility could not be utilized at the time of treatment.

Understanding Post Facto Sanction for Medical Expenses

When you have already paid an empanelled hospital like Manipal and a diagnostic centre like Suraksha Diagnostic Dunlop, and now need to claim the expenses, you would typically apply for a post facto sanction or a reimbursement claim. This process allows you to get your eligible expenses approved after the treatment has occurred.

Key Steps for a Post Facto Sanction/Reimbursement:

• Contact Your Provider: Reach out to your health insurance provider (TPA - Third Party Administrator), or the administrator of the government scheme (e.g., Ayushman Bharat) under which you are covered.
• Understand Requirements: Inquire about their specific process and the list of documents required for a post facto sanction or reimbursement claim.
• Gather Documentation: You will need to submit all original documents related to your treatment. This typically includes:
  • Original hospital bills and invoices from Manipal Hospital.
  • Original payment receipts.
  • Diagnostic reports from Suraksha Diagnostic Dunlop.
  • Doctor's prescriptions and consultation papers.
  • Discharge summary (if applicable).
  • Any other medical reports or test results.
  • A completely filled reimbursement claim form provided by your insurer or scheme.
• Submit Your Claim: Submit all gathered documents within the stipulated time frame (usually 7-30 days post-discharge, depending on the policy/scheme).

Important Considerations:

• Timelines: Be mindful of the deadlines for submitting your claim, as late submissions might be rejected.
• Policy/Scheme Terms: Ensure that the treatment received and the expenses incurred are covered under your specific health insurance policy or government scheme.
• Reason for Post Facto: You might need to provide a valid reason for not opting for a cashless facility or pre-authorization, especially in non-emergency situations.

How HexaHealth Can Assist:

• Guidance on Documentation: We can help you understand what documents are typically required for reimbursement claims.
• Scheme Navigation: If your treatment is under a government scheme like Ayushman Bharat, we can guide you on the process for post facto approval or reimbursement.
• Insurance Support: We can help you connect with your insurance provider's support team and clarify the claim submission process.
• Seamless Experience: Our team can support you in understanding the complex procedures, making your healthcare journey smoother.

It's always best to keep copies of all documents you submit for your records. Please feel free to reach out to HexaHealth if you need further assistance with your claim or navigating the process.