Health Insurance Plans

pays for your hospital bills for diagnostics, surgery etc.

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Cashless Health Insurance Claims

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Put simply, a Cashless Health Insurance Claims is when the medical bills of the Insured are settled directly between the hospital and the insurance company as per the terms of the Health Insurance policy. It is a value added service being provided by the health insurance companies. A great financial assistance since with this facility you don’t have to worry about sourcing funds for payments of Hospitalization fees, surgery and medicine. All you have to do is contact the insurance company timely.

How it works

Health insurance companies facilitate cashless claims directly or through their TPAs (Third Party Administrators). The facility is provided at select hospitals that are listed as the networked or empanelled hospitals. You need to inform the TPA, through the insurance desk at the hospital or directly at the helpline numbers mentioned on the Policy as well as your insurance ID card. TPA may send someone for verification of hospitalization. After verification and other approvals TPA then deals with the expenses as per the policy terms and conditions.

Medical treatment can be either in an emergency situation or can be a planned medical procedure after due consultations with the doctors. Cashless claim can be availed in both the conditions by following proper procedure within the given timeframe. While for a planned hospitalization you have enough time to take care of the pre hospitalization procedures with the hospital and the TPA, emergency hospitalizations need to be reported immediately after hospitalization.

Cashless Claim for Emergency Hospitalization:

Once the patient has been hospitalized, the TPA needs to be informed within 24-48hours. Networked hospitals usually have an insurance desk to help patients with the cashless procedure. First a pre-authorization form is to be filled by the insured which the hospital forwards to the designated TPA. Once the treatment is authorized, the hospital and TPA coordinate with each other. The patient then has to pay only the costs that are not covered in the policy or where the expenditure exceeds.

Cashless Claims for Planned Hospitalization

If you have to undergo a treatment that is planned, the TPA needs to be informed at least 48 hours in advance. A pre-authorization form needs to be filled and sent to the TPA preferably through the hospital. The form can also be sent directly to the TPA. It is important that the TPA gets enough time to process the case and inform about the covered costs so that the balance amount can be arranged by the insured.

The facility of cashless Mediclaim has been able to ease out immediate financial burden on the insured in case of hospitalization. It is looked upon as one of the major benefits of health insurance. Yet it is important to note that all the charges are not payable by the health insurance. These costs are subject to various Exclusions and sub limits. In case of a cashless claim the settled amount is limited to these pre conditions and the rest needs to be arranged by the insured.