One of the most significant advantages of having medical coverage is the ability to file a Cashless Medical Claims. Illness frequently strikes when we are unprepared to deal with it.
At the very least, cashless hospitalization saves you the trouble of arranging funds at the last minute.
If you’ve recently purchased your first health insurance policy, you may have some questions about the cashless claim process, its benefits, and its limitations.
If that’s the case, you’ve come to the right place. This article will walk you through everything you need to know about filing a cashless insurance claim so that you are ready when the time comes.
Advantages of cashless claims
The advantages of having the cashless claim facility in health insurance are self-evident, but they deserve to be stated. To begin with, you avoid the hassle of arranging for funds at the last minute during a medical emergency.
As we all know, the costs of medical care can be exorbitant, often running into lakhs of rupees. Not many people have that kind of money stashed away in their savings. Cashless hospitalization allows you to receive the best medical care without worrying about the cost.
After all, receiving timely treatment comes at no cost. This provides you, the policyholder, with genuine peace of mind at a time when you are already dealing with illness.
Remember these suggestions:
Are you making your first cashless claim? Below are few steps to remember.
Inform as soon as possible
Inform your insurer as soon as possible so that they have enough time to review and approve your claim request. In the event of an emergency, this may be overlooked.
Understand the exclusions.
Make sure to obtain a complete list of exclusions from your insurer. Knowing what you pay for out of pocket will assist you in balancing your expenses while in the hospital. It will also prevent any future confusion.
Decoding Cashless Hospitalization Jargon:
Let’s look at what these terms in cashless health insurance mean.
Hospital network
Every insurance company has agreements with specific hospitals. These are known as network hospitals. Network hospitals provide cashless treatment at rates agreed upon with the insurer.
The insurer benefits from lower claim costs, and network hospitals benefit from the assurance that policyholders will choose their facilities for healthcare.
Administrator (third party) (TPA)
During a cashless claim, the third-party administrator (TPA) acts as an intermediary between the policyholder and the insurance company.
The TPA assists policyholders with queries and even refers them to network hospitals on behalf of the insurer.
The Insurance Regulatory and Development Authority of India must grant the TPA a license to operate (IRDAI).
Examining the cashless claim procedure
A cashless medical claim can be submitted for either planned or emergency hospitalization.
Hospitalization is planned.
If the treatment is scheduled ahead of time, you must begin the cashless claim request at least 5 days in advance. Here are the steps to take:
Step 1: Look up a list of network hospitals in your area and choose the one that is most convenient for you.
Step 2: Fill out the pre-authorization form. This form can be obtained at the network hospital or online through the TPA’s website. The completed form must be submitted to the insurer’s desk at the network hospital of choice.
Step 3: Receive approval with details of sanctioned coverage. For cashless treatment, you must present your insurance ID card or policy number, as well as the authorization letter, on the day of hospital admission. You must ensure that hospital admission occurs within the validity period of the approval.
Keep your insurer’s contact information handy.
Keep your insurer’s toll-free number on your smartphone at all times. In the event of emergency hospitalization, you can get help at any time.
Give precise information
The pre-authorization form will require information such as the patient’s medical history, recommended treatment, pre-existing conditions, and service cost. Fill in these details accurately and truthfully to ensure that your claim is processed smoothly.
Are there any cashless claim exclusions?
Yes, the fine print of your health insurance policy will list exclusions that will not be covered. Medical records charges, laundry charges, phone charges, costs incurred by visiting relatives, nebulizers, diapers, and toiletries are generally excluded from coverage. These must be paid for separately at the hospital where you are admitted.
A cashless medical claim has numerous benefits to offer you, the policyholder. With the cashless claim option, you can concentrate on what is most important: your health. We hope you found this quick guide to cashless claims useful.
