How Does Cashless Mediclaim Work?

Cashless health insurance becomes a blessing in disguise during an expensive surgery or emergency treatment. Cashless mediclaim help patients and their relatives getting rid of financial worries during the treatment. In this blog, let us try to explore various aspects of cashless insurance and see how it works.

Understanding Cashless Mediclaim

Insurance companies possess a certain list of hospitals which are termed as network hospitals. In these hospitals, cashless treatment is offered to the patient who holds the cashless mediclaim from the said insurance company. Cashless treatment means, you need not pay hospital bills but the insurance company will pay for your treatment directly to the hospital. In order to find out the network hospitals covered by your insurance company, check the policy booklet or call the customer care on their toll-free or premium numbers.

Procedure for Cashless Claim

• Get hold of the pre-authorization form from the TPA desk in the hospital. TPA is referred to Third-Party Administrator who is deputed to fix all the issues related to claim settlements.
• Fill the form and submit back at the TPA desk. This will help TPA process your request for the cashless treatment and issue you a sanction letter mentioning the treatment amount.

Benefits of Cashless Policy

By opting for cashless health insurance you are entitled to get treated without paying any hospital bills. The insurance company settles the bill and pay directly. The only thing which you should keep in mind is that the claim should not exceed the sum assured. The good part is that this facility is available for both planned and emergency admits in the hospital for treatment. Though your policy covers hospitalization and treatment at any hospital across the country, the cashless facility will only be available at the network hospitals covered by your insurance company.

Distinct Categories of Policy

Health insurance policies are generally categorized into two segments, cashless and reimbursement. Under a reimbursement policy, the patient needs to pay all the hospital bills upfront and claim the amount later after getting discharged from the hospital. This is done by submitting all the bills at the TPA desk along with the discharge summary. Later all the bills are screened and the sanctioned amount will be directly transferred to your bank account.

Whereas in cashless, as already stated, the hospital will get all your hospital bills settled directly from the insurance company.

Why Go for Cashless?

• The cashless policy is beneficial for the ones who are low on savings and have no liquid cash available upfront for the treatment. By paying an affordable annual premium you are covered for a handsome amount of cashless medical expenses during the admission and treatment at the network hospitals.
• In this case, you need not segregate and preserve the bills and other documents to get the claim hence it becomes hassle-free.
• In case of emergency admission, the patient and relatives need not to be worried about arranging the cash for treatment. This not only helps you monetarily but also save patients life by allowing them to get treated without any delay.

Things to Remember

• You can avail cashless treatment in the network hospitals but it limits your choice of hospitals. If you choose to go to the hospital of your choice for the treatment, then reimbursement is the only option.
• Do not think that everything during hospitalization and treatment will be covered under a cashless policy in the network hospitals. There are many expenses like disposal items, ambulance charges, and attendant fees etc. which are not covered by the insurance companies.