How Do Cashless Claims Work In Health Insurance?

Enduring unresolved health complications can be a highly traumatic experience. Not only do you have to deal with a wide range of emotional issues but, you also have to ensure that your financial requirements are adequately met.

However, most health insurance plans today are based on a reimbursement system. This implies that you will incur all the immediate hospitalization expenditures and would have to pay it from your own pocket. Nonetheless, you would be free to raise a claim for its reimbursement at a later stage. This claim would have to be accompanied by a docket of pre-defined bills and required documentation. Moreover, a number of other formalities prescribed by the insurer will also have to be completed. Even after making all of these submissions, the total amount sanctioned might not fully cover the actual expenditure.

This is why it comes as no surprise that most people have now begun to opt for cashless health insurance claims.

What Are Cashless Claims and How Do They Work?

As the name itself suggests, a cashless health insurance policy ensures that all your medical transactions are managed in a cashless way. In other words, neither do you have to foot your own bills, nor are you required to file for post-dated reimbursements.

Instead, all you have to do is adhere to the following process:

In case of planned hospitalization:

  • Choose an empanelled hospital which is registered on the insurer’s network.
  • Fill out the pre-authorization form and get it certified by the attending physician.
  • This form would be sent over to a third-party administrator (TPA) who will verify its validity.
  • The TPA will either approve or reject your cashless health insurance
  • In case of approval, all the hospital bills up to the approved amount would be directly settled with the hospital.

In case of emergency hospitalization:

  • Fill out the pre-authorization form and have it stamped by the attending physician.
  • Fast track the process of sending the form to a TPA.
  • The approval would be granted and the payment would be made within 6 hours.
  • Contact your health insurance policy provider, if you want to further speed up the claim.

What Expenses Does a Cashless Health Insurance Cover?

Although most cashless health insurance plans provide a variety of different benefits, they usually cover standard expenditures like:

  • Pre and post hospitalization expenses.
  • Room, ambulance, and medicine charges.
  • Critical illness diagnosis and treatment.
  • Free health check-ups.
  • Medications for chronic illnesses.

Nevertheless, the cashless health insurance policy does not cover:

  • Hospital registration fees.
  • Dietary charges.
  • Documentation charges.
  • Attendant or service charges.
  • Equipment expenses.

Things to Consider

Before you decide to opt for a cashless health insurance policy, here are a few things, which you must bear in mind:

  • Cashless health insurance service can only be availed in select hospitals.
  • All information must be provided in the pre-authorization form in order to ensure that your claim is not rejected.
  • The health insurance plan covers a limited set of ailments.
  • The total amount that has been approved for your cashless health insurance is dependent upon the premium you pay.
  • This facility is subject to the insurer’s terms and conditions.

A cashless health insurance harbours the potential to curtail your expenditure while giving you the freedom to explore different medical options. Availing such a policy in the current era, which is ridden with numerous financial complexities can prove to be a highly effective and efficient way of dealing with health-based exigencies.