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Apart from all the emotional suffering, an out-of-the-blue medical emergency can dig deeper into your lifetime savings. This is precisely why you must invest in a good health insurance policy to ensure that you get sufficient financial aid during any kind of emergency.
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 saviour.
With the alarming rate of inflation and upsurge in medical expenses in India, hospitalization and all the associated treatments are becoming costlier. Unless you were born with a silver spoon, you need to pre-plan to tackle any medical emergency. Health insurance policy, supplemented with cashless claim settlement, is one such element that needs to secure a place in your financial plan.
In short, if you are admitted in the hospital but do not have any emergency funds to pay off for your hospital bills, then the cashless hospitalization acts as your saviour. If you inform your insurance company about your hospitalization, they would directly settle the bills with the hospital rather than you having to first pay the expenses and then wait for your insurer to reimburse the money to you.
Cashless health insurance policies are designed with the sole intention of providing the much-needed financial relief to the policyholder at the crucial time of hospitalization. It is an arrangement of the insurance companies and their network hospitals, where the claims are settled without involving the insured. Under this arrangement, Third Party Administrator (TPS) acts as a bridge between the hospitals and the insurance company in settling the claims. In most cases, these TPAs set up a desk at the network hospital to facilitate smooth processing of such claim requests.
For the treatment of a pre-existing disease
Every insurance company is in a tie-up with certain hospitals that form a part of their Preferred Provider Network or PPN. When you plan to get treated in such hospitals, you can avail the cashless claim settlement facility. To avail it, you need to do the following:
For an unexpected event like an accident or a critical illness
In an unforeseen situation like an accident or a critical illness, if hospitalization is required, then the policyholder or his/ her family members should follow the following procedure:
While your health insurance policy tackles any financial blows resulting out of hospitalization, there are certain items that are not claimable in spite of being a part of your medical expense. Some of them are mentioned below:
I live in Ajmer, how can I know the hospitals that will allow cashless treatment?
The detailed list of all the network hospitals is available with your insurance company. If you have still not received the same, please contact your insurance company for an update. Simultaneously, you can also access this information through the online portal of your insurer.
What could be the possible reasons for denying my request for the cashless settlement?
As per the strict IRDAI guidelines, the insurance company/TPA cannot deny your request for cashless treatment unless there’s a valid reason to do so. Some of these reasons could be that:
Can I opt for cashless treatment for OPD Procedure?
Because OPD treatments are not covered in your health insurance policy, you cannot opt for cashless treatment for them. However, if it’s a part of hospitalization that is covered by the insurance company, you can claim the amount.
I am soon to deliver a baby, can I request for a cashless settlement?
Congratulations and all the best! The good news is – yes, you can opt for the cashless treatment. You will have to refer to your policy wordings to check the waiting period and the scope of coverage related to maternity.
I have lost my health card, can I still opt for cashless treatment?
If you have lost your health card, you should intimate your insurance company/TPA as soon as possible. Further, it's entirely at the discretion of the insurance company/TPA to accept or reject your request for cashless treatment. Some TPAs/insurers allow their policyholders to proceed with treatment on the basis of KYC documents, if the health card is not available.
Cashless settlement of hospitalization expenses is one of the biggest advantages of health insurance. In times, when you are already emotionally fragile, what can be more comforting than a financial respite to reduce your worries and stress?