My mother has to undergo chemotherapy sessions. Do I need to take insurance approval for each session?

My mother has to undergo chemotherapy and she requires 6-8 sessions as advised by the doctor. Do I require seeking approval every time whenever my mother undergoes the therapy?

Name withheld 

Reply by Parthanil Ghosh, Director & Chief Business Officer, HDFC ERGO General Insurance

First of all, I wish a speedy recovery to your mother. In some cases, insurers may require approval for the overall treatment plan rather than each individual session. Once they concur on the initial treatment plan, you might not need to take more approvals for follow-up sessions at the same hospital. Also, there are some insurers who provide a single approval for all sessions at the start of the treatment provided the treatment will take place in the same hospital as per physicians’ advice. But just to be on the safer side, it is a good idea to check with your insurer.

Also, while seeking approval, several factors may merit your consideration:

Pre-authorisation Process: Some insurers may require pre-authorisation for each chemotherapy session. This process involves submitting necessary documents, including the treatment plan, medical reports, and other relevant information, to the insurer for review and approval. It is essential to follow the pre-authorisation process as per the insurer's guidelines.

Timely Communication: Regardless of the approval process, it is crucial to maintain open communication with your health insurer. Keep them informed about the prescribed number of chemotherapy sessions and ensure swift provision of any required documentation promptly to facilitate coverage and prevent potential delays in reimbursement.

Coverage and Policy Limits: Familiarise yourself with the scope of coverage and limits set by your insurance company concerning chemotherapy treatment. Ensure that the number of sessions recommended by the doctor falls within the coverage limits specified by the policy. If there are any limitations, discuss potential alternatives with the insurer. Also, there might be some exclusions for mode of treatment, which will vary from insurer to insurer, hence it is prudent to check terms and conditions of your policy beforehand.

Treatment Modifications: If there are any modifications or adjustments to the treatment plan during the course of chemotherapy, such as changes in medication or dosage, you must inform your insurer promptly. This allows the insurer to evaluate the changes and ascertain the need for additional approvals.

Emergency Situations: In case of an emergency where immediate chemotherapy is required, seeking pre-approval may not be feasible. In such instances, inform the insurer as soon as possible to ensure hassle-free reimbursement process.

Continued Follow-up: Throughout the treatment process, it is essential to keep the insurer informed about the progress of the chemotherapy sessions. This may involve sharing medical reports, updates from the treating physician, and any changes in the treatment plan.

It is important to note that every insurance policy is designed as per the profile of the insured and therefore it is advisable to carefully review the terms and conditions of your policy. Consult with the insurer, and maintain open communication to ensure that your mother's treatment is appropriately covered and that the claims process is smooth and hassle-free.

(Views expressed by the expert are his/her own. E-mail us your queries at askmoneytoday@intoday.com. We will get your queries answered by our panel of experts)