Cashless health insurance allows for faster claim settlement 

7 MinsNov 19, 2021

One of the biggest deterrents when it comes to buying health insurance is perhaps the time taken for claim settlement. Some common complaints are the insurance company misplacing the medical bills and the policyholder having to go back to the hospital for duplicate copies. Or the insurer settles only a part of the claim amount. Or the claim is approved but the reimbursement is delayed and as a result, the policyholder faces a temporary shortage of funds.

cashless health insurance

To reduce all these hassles, opt for a cashless health insurance policy. Let us understand how it works and its advantages.  

What is cashless health insurance?
Cashless health insurance is literally what it sounds like. People covered by it don’t have to pay any cash if they are admitted to a hospital for any medical procedures. The insurance company takes care of it.

How does it work?
Every health insurance company has tie-ups with hospitals where its customers can be treated on a cashless basis. Such hospitals are called network hospitals. If a patient is admitted to any of the network hospitals, then the treatment is cashless.

This is how the process generally works:

  • A policyholder should choose a hospital from the insurance company's network. Since most providers have a broad network of hospitals, this is generally not a problem.
  • If the medical procedure is pre-planned, the insurance company should be given 48 hours prior notice. In case of an emergency, the insurance company needs to be informed within 24 hours of hospitalization.
  • The policyholder has to fill a pre-authorization form at the insurance company’s desk (most often manned by third party administrators retained by the insurance company) along with documents like ID proof, policy document and medical papers recommending the procedure.
  • These documents are then forwarded to the insurance company's office, and once the approval is received, cashless treatment can start. If it is an emergency where the procedure cannot be delayed, for example, surgery in case of a heart ailment, then the hospital may decide not to wait for the insurance company's consent. In such a case, the hospital may ask for an upfront payment before starting the treatment. Such charges are, however, adjusted against the final insurance claim.
  • Once the insurance company approves the claim, the policy will take care of all major expenses for the treatment. Most often, depending on the exclusions in the policy, the patient or their family may have to pay only a small amount that is not covered by the claim.

What happens if the cashless claim is rejected or the patient cannot go to a network hospital?
Generally speaking, if the policy is current and patients or their family members follow proper procedures, the rejection ratio of claims is relatively low. Even in that scenario, or if the patient is not admitted to a network hospital, the insurance cover is still valid. The patient will have to pay for the treatment and then file for reimbursement.

What are the benefits of cashless health insurance?
The most crucial benefit of cashless health insurance is that in case of a medical emergency, the patient does not have to worry about liquidating savings or worry about raising funds.

The other great advantage is that since cashless insurance is an arrangement between the insurance company and the network hospital, most paperwork exchange happens directly between them. As a result, the burden on the patient to provide the required paperwork is far less than what it would be if it were a reimbursement claim.

The third advantage is that network hospitals typically offer a better quality of service and treatment.

[Also Read: 8 Factors to Consider While Buying Health Insurance Cover]

Things to watch out
As with any financial decision, health insurance – cashless or reimbursement – comes with caveats that the policyholder should know. Prominent among these include:
Exclusions: Depending on the health insurance plan, certain medical procedures may be excluded from the coverage. The policyholder may have to pay for this out of their pocket.
Room expenses: Many health insurance plans come with a limit on what kind of room (in terms of costs) the patient is admitted to. Remember that an upgrade in the room is most likely to result in higher charges on a whole host of other procedures and services.

It is advisable to read the policy document carefully to understand what is covered by the insurance company and what isn't. This way, there are unlikely to be any rude surprises.

Axis Bank has tied up with Tata AIG Health Insurance, Aditya Birla Health Insurance and Digit Group Insurance to offer its customers a range of cashless coverage options.

Disclaimer: The Source, a content creation and curation firm has authored this article. Axis Bank does not influence the views of the author in any way. Axis Bank and The Source shall not be responsible for any direct/indirect loss or liability incurred by the reader for taking any financial decisions based on the contents and information. Please consult your financial advisor before making any financial decision.