A health plan is important to meet any financial expense due to an illness or an emergency hospitalization. Insurers offer various types of health plans with attractive features to maximize your benefits.
One such feature offered by most insurers is the cashless facility within the network facilities. Here is how the cashless facility works:
How does cashless health insurance work?
When you have a health insurance plan, there are primarily two ways to file a claim. First is to pay the healthcare expenses through your own sources and then claim reimbursement. The second method is to file for a cashless facility.
When you take treatment within the insurer’s network facility, you must show the card to avail of the cashless facility. This ensures you do not have to pay anything from your pocket and the insurer will directly settle the hospital bill.
The process of filing a cashless claim
- Check the hospitals within the insurer’s network
- Once you decide on the chosen facility, you need to download the pre-authorization form from the insurer’s website
- Submit the form at the insurance desk of the chosen hospital
- A third-party administrator (TPA) verifies the form prior to providing confirmation on the cashless facility
It is important to note that your cashless health insurance claim may be rejected if the illness is not covered under the policy, the sum assured has already been used, or if the waiting period is still not over.
Here are some points you need to remember while filing a cashless claim:
- Being prepared
It is very important that you read the policy document carefully and understand all the terms and conditions along with the inclusions and exclusions. Moreover, keep the policy document and identity card safely so these are easily accessible in case of an emergency. It is recommended that you carry the cashless insurance settlement card at all times to ensure timely treatment.
- Planned hospitalization
In case of a planned hospitalization, it is recommended that you do not delay sending the authorization form for approval. This ensures that you do not have to wait due to pending documentation or incorrect form filling.
The insurers provide the expected turnaround time (TAT) to approve your cashless request in the policy document. Therefore, it is important that you check the same to avoid any delay.
- Complete the form accurately
A part of the authorization form may have to be completed by the doctor and due to his busy schedule; there may be errors in the same. You must check that all the details are filled accurately to ensure that there are no unnecessary delays.
In case the request is not accepted due to incorrect or incomplete paperwork, you may still file for reimbursement from the insurer.
Benefits of cashless health insurance facility
- A cashless mediclaim policy ensures there is no delay in starting the treatment in case hospitalization is required due to an emergency
- You do not have to worry about paying the hospital bills and other costs while you or your loved one is being treated
- Most insurers have a large number of hospitals within their network ensuring you receive timely treatment
- In case of the diagnosis of a critical illness, you do not have to compromise on the best treatment due to lack of funds
Just purchasing a health plan is not enough. You need to understand the process and regulations associated with cashless claims to avoid trouble when the need arises.