Categorized | Health Insurance

how to get a cashless health insurance claim?

Health insurance policies are need of the hour. With increasing medical expenses and health Risk factors, Health Insurance will serve as a savior during the most critical periods. The idea of health insurance plan in most of the insurance companies is to allow you to Claim Reimbursement after you have paid for your medical emergency. With cashless health claim policies now you can direct your medical bills to your insurance company. If your Policy covers the prescribed treatment or emergency, you won't have to shell out a single penny during your hospitalization.

WHAT IS CASHLESS HEALTH INSURANCE?

This kind of policy enables you to undergo treatment at a hospital without paying a cent as hospital charges. If the hospital is one of the featured hospitals in the health insurance policy, the insurance company will directly settle the bills. Thus, the Policyholder or his immediate family can undergo any medical emergency without the need to worry about the bills.

In case of hospitals which are not listed in the insurance company's network, you will have to pay the bills yourself and claim reimbursement with the Insurer later.

TYPES OF CASHLESS SERVICES:

1.Emergency hospitalization
2.Planned hospitalization

Emergency Hospitalization will require immediate action from the TPA and hospital authorities to finish the cashless service proceedings. Your Insurance Agent or consultant may be of help during such crucial stages to finish the authorization procedures.

Planned hospitalization doesn't involve risks as such in emergency hospitalization. The formalities can be finished a week prior to the surgery date or treatment period.This relieves the Insured person from any kind of formalities at the neck of the time and can undergo a peaceful period of hospitalization.

HOW CASHLESS SETTLEMENT WORKS?

The insurer provides the policyholder a cashless settlement card. During medical emergencies the hospital authorities utilize the card number to claim their medical charges from the insurance company.
 
In cases of cashless services, a Third Party Administrator is involved, acting on behalf of the insurance company, to verify the policy covers and cash-flow limits. If the policyholder is covered for all the prescribed treatments or surgeries the TPA gives clearance to the insurer to process the cashless settlement.

NECESSITY OF CASHLESS MEDICLAIM:

The purpose of Mediclaim is to reduce the economic burden on a person during medical emergencies. Paying the medical bills during the hospitalized period and claiming reimbursement later doesn't ease the economic burden much on the policyholder. Thus several insurance companies have come forward with the innovative Cashless settlement policies which are considered more customer friendly, thereby actually reducing the economic burden when needed the most.


HOW TO CLAIM CASHLESS MEDICLAIM?

1.The policyholder had to inform the hospital administration about the cashless insurance cover at the time of admission.
2.The hospital authorities will provide the necessary authorization forms and the claimant must ensure that he has filled in the precise details.
3.The formalities once finished are subject to verification by TPA.
4.TPA verifies the policy details and has the right to approve or deny the claim made by the policyholder.
5.Once the cashless settlement is approved the insurance company agrees to pay the hospital charges.
6.Charges which are not covered under the policy will have to be met by the customer himself.


COMPARE AND CHOOSE

Cashless mediclaim might seem a very relieving policy; in reality it might be more complicated than regular health insurance policies. Studying in detail about the procedures and covers provided by the mediclaim is important as false claims and misleading promises might land the policyholder in trouble during the most critical period. Meeting up with a licensed consultant or Insurance Broker will help you to choose better. A foolproof mediclaim and an agent are a necessity to completely enjoy the actual privileges. Compare and choose between the policies on the basis of your budget and the availability of networked hospitals near your home.


THINGS TO REMEMBER

1.If you are provided with a cashless settlement card, carry it always.
2.Identify the featured hospitals and choose the ones that are close to your working place and home.
3.In case of surgeries, finish the authorization formalities at least 3 days before the surgery date.
4.Renew the policy and pay the health insurance premiums regularly, for the insurance to provide cover for any of your expenses.
5.Provide contact numbers of family and friends to your insurance agent for the TPA to clear formalities during accidents.