Cashless Health Insurance – A Complete Guide

Cashless health insurance is a significant benefit for policyholders and fulfills the real intent of holding an insurance possible in the best way.

But, in reality, how many policyholders really make good use of it and reap its benefits? Not many insurance buyers are acutely aware of how to make a claim using cashless health insurance policy and are often confused how it works. So let’s examine in detail about the cashless claim feature.

An Introduction to Cashless Health Insurance

When you are hospitalized and file a claim, you can make that claim in two ways. One way is the traditional method of paying the hospital bills yourself and then claiming for a reimbursement from the insurance company based on the hospital bills.

Another way is to avail the cashless facility wherein you need not pay upfront. You are required to get hospitalized in a certified network hospital that has a tie-up with the insurance company and simply show your identification card or insurance card to the hospital. The insurance company will then take up the responsibility of settling the bill with the hospital.

The technical definition of the cashless facility is as follows. It is a service, where the cost of the treatment undergone by the policyholder, by the policy terms and conditions, is directly made to the networked hospital by the insurance company to the extent of the approved pre-authorization.

Undoubtedly, the cashless facility is an excellent form of making a claim since you don’t have to pay unnecessarily to the hospital. However, to use this feature, the policyholder has to follow the process and paperwork.

Process of Cashless Facility

First and foremost, you can avail the cashless health insurance facility only in one of the network hospitals. Usually, you will find the list of network hospitals in the insurance provider’s website. So make a decision of the hospital accordingly and download the pre-authorization form.

In the case of a planned hospitalization, you would be required to submit this pre-authorization form within a stipulated time-frame by the insurance policy. In the event of an emergency hospitalization, the insurance company must be notified within 24 hours and the form must be submitted to them.

Once the form is submitted, the insurance company or third party administrator (TPA) will assess it. If approved, the TPA will communicate the same to the hospital, and the cashless facility can be availed for a specified limit. If your cashless claim is rejected on grounds of inaccurate details, waiting periods, exclusions, exhaustion of sum insured amount, pre-existing illness, etc., you will be notified about the defects.

Important Points to Take Note Of

Be aware of the terms and conditions of your health insurance policy. When making cashless claims, it is necessary to adhere to all the due formalities.

• Stay Prepared – Make a list of the network hospitals and identify the most nearby hospital in your vicinity. Read the wordings of your policy document to know your coverage and what you are eligible for. Keep a hard copy of your policy document and ID cards in an easily accessible and safe place.
• Always carry your cashless claim card – In the case of emergency, you will be asked to submit your cashless settlement card. So, if you don’t have one or misplace it, ask your insurance company for it.
• Planned Hospitalization – If it is a planned hospitalization, send out the pre-authorization form in advance to the insurance company to avoid any hassles. Don’t wait until the last minute to send it.
• Maintain a Contingency Fund – Even though you have the cashless feature in your health insurance, you may have to shell out for certain expenses like registration fees, refundable deposits, etc. So, allocated emergency funds for the same and don’t over-rely on the cashless facility.
• Fill the application forms accurately – Failure to provide accurate details of the hospitalization will lead to rejection of claims. So make sure to fill in the right details and mention your mobile contact numbers in the pre-authorization form, so that the TPA can keep in touch with you.
• If your cashless claim is rejected on the ground of inadequate paperwork, you can still settle your claims with the traditional method of reimbursement.
• Insurance companies have a turnaround time (TAT) to approve your cashless requests. Check the policy document for the same and ensure that they adhere to it.
• In the case of complaints or grievance, approach the insurance company. Or else you can also escalate your complaints to the IRDA or consumer forum.
• Maintain and organize all medical bills, reports, lab reports, etc. in a folder or file as you will be asked to submit the same after making any claim. Always keep copies of the entire set to refer again.
• Cashless Facility can also be utilized for a day-care procedure that does not require more than 24-hour hospitalization.
• If the insurance revokes its tie-up with a network hospital in the middle of your hospitalization, your cashless claim would still be honored
• Always renew your policy on time

While a health insurance policy does provide you coverage against hospitalization costs, you might still be required to pay for it from your own pocket before raising a claim. This may not be the most ideal situation for people with no extra savings to shell out.

This is where cashless hospitalization plays a savior.

I am an expert writer in Insurance Industry and have knowledge about various insurances online like Car Insurance, Two-wheeler Insurance, Health Insurance.