Reimbursement V/S Cashless Claim Settlement Process

The insured has to be treated in an impaneled hospital in order to opt for a cashless mediclaim facility. He or she can avail cashless hospitalization and treatment by presenting the e-card or providing the details and other details of the health insurance policy taken in the name of the policyholder. All the medical bills are sent to the insurance company provided by the hospital as soon as the patient is discharged from the hospital. After the evaluation of the expenses, the payment is settled by the insurance provider. The claims process for treatment at a cashless mediclaim network hospital may vary according to the type of treatment that is planned or unplanned. In an unplanned mediclaim policy cashless claim process usually happens in case of emergency.

If the policyholder opts to go to a hospital of his/her choice that is a non-impaneled hospital the reimbursement mediclaim policy claim for health insurance can be made. In this case, the cashless mediclaim facility cannot be used. Before claiming the reimbursement insured has to pay all the costs and medical bills involved in treatment and hospitalization. You have to provide the necessary documents including the original bills to the insurance provider in order to avail reimbursement claim. Before making the payment to the insured, the company first evaluates the claim to see the scope under the policy cover. The claim will be rejected in case the claim is not covered under the policy. Generally, reasons are provided by the insurance provider for rejection of the claim.

Advantages:

There is no need of emergency cash as cashless policies help you to avoid the pain of running around and gathering money during a financial emergency. A cashless claim is considered as the best mediclaim policy as it settles the claim instantly. The stress of having to ask somebody else for financial policy help is not required in the case of cashless policy.

In case of reimbursement claim settlement, the insured can get the bills settled on a later date and get the treatment in any hospital as per his/her choice.

Disadvantages:

In case of cashless claim settlement hospital must remain in the insurer’s network. In order to avail cash benefit, you have to seek hospitalization only in a network hospital. The cashless facility will not work if the insured chooses to receive treatment elsewhere.

Reimbursement claim settlement is not considered as the best mediclaim policy because insured has to face the financial strain of any hospitalization or treatment. Reimbursement can be processed only when the treatment is complete and the patient is discharged from the hospital. For availing reimbursement of your claim a lot of reports, other supporting documents, and bills are required to be submitted to the insurance company. Reimbursement claims usually take a lot of time. Every Insurance company wants their customer to have a hassle-free claim settlement process and thus they recommend customers to opt for cashless claim settlement process. Thus it totally depends on the customer which option they want to choose keeping the advantages and disadvantages of both the policy in mind.

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