Do’s and Don’ts a Policyholder Must Know While Buying Cashless Health Insurance

With the latest buzz about cashless economy, there is a paradigm shift within the people to switch to other means and modes of payment apart from cash. In health insurance fraternity, cashless health insurance was concerted way back. It is the most important feature of the health insurance policy where the policyholder can a cashless treatment in the listed network hospitals.

In case of any emergency medical  situation, usually we are worried about depositing money in the hospital to kick off the treatment but with cashless health insurance plans the process is hassle free and convenient. But many of us still do not know how exactly the cashless hospitalization works.

There are basically two situations where cashless health insurance can be availed:

  • Planned Hospitalization
  • Emergency Hospitalization

How the Cashless Health Insurance Plans work?

  • The policyholder has to show his health insurance card at the insurance counter of the hospital specifying his/her policy details.
  • The pre authorization form needs to be filled which is then scrutinized by the insurance helpdesk counter of the hospital and sent it to the third party administrator (TPA) or the Insurance company in case of in-house claim settlement team.
  • TPA will process the claim form and can either approve or reject the authorization for cashless treatment. In case of approval, TPA or the Insurance company will send a go ahead approval to the hospital in the form of authorization letter.
  • The other documents required by the policyholder to furnish are photo id proof, past medical records, etc.

Do’s

  • Read the policy document and wordings carefully to eliminate last minute surprises in the policy.
  • Make a list of network hospitals near your residence, so that in case of emergency, you know which network hospital you should rush to avail cashless hospitalization facility. The insurance company has to display the associated network hospitals under its panel on its website always as per regulator’s regulations.
  • It is important to carry the cashless health card and other important documents like photo id proof, past medical records,etc. which will help you to avail the cashless hospitalization with ease.
  • Fill the pre authorization form correctly,so that the authorization should not be rejected on the basis of wrong information provided in the form.
  • Understand the process of cashless hospitalization before hand and share it with your family members which will help to speed up the process in case of emergency hospitalization.
  • In case of planned hospitalization, it is important to go through the formalities and documentation required at the time of availing cashless services before hand in a planned way.

Don’t

  • Delay to intimate the TPA or insurance company about the hospitalization.
  • Skip to read the fine print of the policy wordings.
  • Hide material facts or other important information in the pre authorization form.
  • Rely on non network hospitals for cashless hospitalization.
  • Assume that the entire hospitalization bill amount will be paid by the insurance company it is subject to your sum insured, policy coverage and policy conditions.

Factors which can lead to denial of the cashless hospitalization:

  • If the disease or illness is not covered under the coverage of the health insurance policy
  • If the hospital fall under non network list of hospitals. In such cases you may pay the hospitalization expenses and later can get them reimbursed from your insurer
  • If the pre-authorization form is not filled correctly or is incomplete
  • If additional information and/or documents are not provided to the TPA in stipulated time frame
  • If the sum insured under the health policy is exhausted for the policy year

Read our article “Health insurance Strategy” for understanding more about Health Insurance.

Health insurance is vital in today’s sky rocketing cost of health care. It is important to analyze, compare the premium, policy benefits, inclusions, waiting period, key features, etc. before buying Insurance plan. Undersand the process of cashless hospitalization beforehand to avoid last minute hassles.

Harjot Singh Narula

Harjot Narula is founder and CEO of ComparePolicy.com, an IRDAI approved insurance web aggregator focussed on selling online insurance for companies. Harjot has more than a decade of experience in software development and has also spent 5 years in US working for the mortgage and risk management industry.

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