How Does Cashless Insurance Work?
A health insurance company has certain list of hospitals present across India which is known as network hospital. This hospitals are where they offer cashless benefit i.e. when you get a treatment at these hospitals, you do not have to pay the bills.
Elaborately, in case of a ‘cashless’ treatment, your medical bills are directly paid by the insurance company to the hospital. To find out about the network hospitals, you can check your policy document or visit insurance company’s website or contact your insurance the company on their toll-free number.
What Is the Procedure?
• Check the insurance company’s website and decide on the network hospital you would want to get admitted.
• Next, ask for a pre-authorization form from the insurance desk of the hospital. Every hospital has an insurance desk to clarify all queries related to the patient’s insurance policy. You can also download the form from the TPA’s website.
• Fill up and submit the form to the insurance desk. The TPA will process your form and send you a letter sanctioning the treatment amount.
Why Cashless Health Insurance?
In cashless health insurance, you do not have to pay any hospital bill in order to get treated. The insurance company directly settles the bill with the hospital. However, the bill amount should not exceed the sum assured. The facility is available for both planned and emergency hospitalizations. While your health insurance covers hospitalisation anywhere in India, cashless service can be availed only at ‘networks hospitals’.
Cashless v/S Reimbursement:
Health insurance policies come under two distinct categories:
• Reimbursement: Under a reimbursement policy, you will have to pay the; medical bills upfront during and after treatment when discharged from the hospital. You will, then, have to file a claim with the TPA by submitting the bills, medical reports, documents and doctor’s certificate. Once processed, the insurance company would deposit the claim money directly into your bank account.
• Cashless: Under the cashless policy, the hospital will get your medical bills settled directly with the insurance company.
• Liquid cash is not easy to come by. Most people don’t have a huge amount lying around to avail at short notice. Cashless hospitalization is a boon for people who are low on cash or have limited cash reserves. The patient’s bills are settled directly by the insurance company with the hospital without the patient’s direct involvement. Hence, this is a stress-free way of availing hospitalization benefits.
• You don’t need to retain and submit all the documents, reports, discharge sheets for claim. Thus, it is less cumbersome.
• In case of an emergency, you can get admitted without worrying about money.
• Since the insurance company pays your claim (up to sum assured) during hospitalization, there is no waiting period. This is unlike the reimbursement policies, where claim settlement happens after you are discharged.
Points to remember
• You can avail the cashless facility only at the network hospitals. This could limit the choice of hospitals for you. If you choose to go for a hospital which is not in the network, reimbursement is the way out.
• Not all expenses in the hospital come under the cashless scheme. Attendant/visitor fees, private nurses, ambulance charges, expenses
for oxygen masks, diapers, etc. are usually not covered by the insurer.
• Read the conditions and terms in the cashless policy carefully. Every health insurance policy excludes some illnesses from insurance cover. There could also be an upper limit on cashless transactions.
Also Read: Do's and Don'ts a Policyholder Must Know While Buying Cashless Health Insurance