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Cashless Health Insurance

A medical emergency is one of the most difficult situations in anyone’s life as it doesn’t come with a warning and can hit you at any time of your life. In addition to the suffering of the loved ones, running to hospitals and getting the best medical facility makes things more complicated. With the increasing cost of health care services, getting the best medical facility is becoming an expensive proposition. Arrangement of cash in such emergency becomes a hassle for most of the people as everyone wants the best medical facility for treatment which costs a lot. But a cashless health insurance can act as a savior for you in such situation.

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Cashless Health insurance

Cashless Health insurance is a type of health insurance, which offers an insured person the benefit of availing the best medical facility without paying from his own pocket as all the hospital bills covered under the policy is paid directly by the insurance company to the hospital. The approval by TPA (Third Party Administrator) plays an important role in availing a cashless treatment.

Types of cashless mediclaim service

Following are the two types of cashless mediclaim services which you can avail:-

Planned Hospitalization

When an insured person knows that he will get hospitalized in a few days, then he can plan for the hospital he will choose and services he will avail. Such type of hospitalization is called planned hospitalization and you need to take a pre-authorization at least a few days before getting hospitalized.

What to do?

  • Choose the best and nearest hospital from the list of network hospitals of the insurance company.
  • Visit the hospital with the policy card and fill the pre-authorization form, which can be taken from the hospital or TPA’s website.
  • Submit your form which will be cross checked by the TPA after which he will either accept it or reject it.
  • After acceptance by the TPA, an authorization letter will be sent by him, which will be containing the details of amount sanctioned.

Emergency Hospitalization

When an insured person needs immediate hospitalization due to accident, grave illness or any other emergency situation, then such type of hospitalization is called emergency hospitalization.

What to do?

  • Show your policy card at the hospital
  • Inform the TPA and if you don’t have time to wait for the approval of the TPA then you can pay for the medical expense and then reimburse it later. But according to the protocol, a TPA should process a claim within 6 hours in an emergency situation.

Points to remember before availing cashless mediclaim facility

  • Cashless service can be availed at network hospitals only.
  • Always keep a photocopy of all the documents like medical bills, lab report, claim form and discharge paper.
  • Understand the limitations and allowance under your health insurance policy because there are many cases in which you are not covered under the policy and there are also some limitations like sub limit, exclusions etc. in your policy.
  • Sending a timely intimation to the TPA regarding hospitalization is very much important.
  • A part of the sum insured is usually paid to the patient and if you exceed the amount of sum insured then you will have to pay for the extra amount from your own pocket.

What is not covered?

  • Ambulance Charges
  • Documentation Charges
  • Service Charges
  • Visitors Fee
  • Expense for oxygen mask, diapers, nebulizers, etc.
  • Routine medical exams
  • Injuries or medical condition caused by terrorist acts or war
  • Dental Procedures

So don’t panic in case of an emergency medical situation as a cashless health insurance policy can help you in availing the best medical facility without paying anything from your own pocket. You must inform the TPA in advance and should carry the required documents to avail cashless treatment without any hassle.