What Is Cashless Hospitalization and How Does It Work?

Limited Health Insurance penetration, followed by rising treatment expenses for chronic diseases such as coronavirus, cancer, diabetes, and heart disease, as well as low government investment on healthcare, are some of the causes behind this. In the event of a medical emergency, a patient must not only deal with physical and mental pain, but also the financial strain of assembling sufficient funds to cover hospitalization costs as soon as possible. During such a moment, a cashless mediclaim policy can help you avoid standing in long ATM lines for cash disbursement or relying on relatives for assistance.

Cashless Hospitalization

In 2002, the Insurance Regulatory Authority of India (IRDA) established a cashless hospitalization system. Those who purchase health insurance coverage through a third-party administrator can receive cashless treatment at this institution. It is only available in designated hospitals that are part of the insurer's network of facilities, as listed in the policy document, subject to certain terms and conditions.
A cashless mediclaim policy eliminates the hassle of paying the hospital upfront at the time of admission. At the same time, you can rest confident that you will receive the greatest medical care at the top hospitals with cashless hospitalization and a sufficient sum insured.

How Does Cashless Hospitalization Work?

Now that you know what cashless hospitalization is, let us look at how you can use this cashless mediclaim service.

1. Planned Hospital Admission

Assume you or a member of your family will be admitted to a hospital for minor surgery. For cashless treatment, you must notify your insurance carrier in advance by filling out a pre-authorization form available on the TPA website or at the hospital insurance desk. The form must also be filled out by the concerned physician. This form is then submitted to the hospital's insurance helpdesk, where it is confirmed before being forwarded to the TPA, who verifies the information once more. Once this is completed, the sum is sanctioned, and an authorization for cashless mediclaim is issued to the hospital.

2. Emergency Hospital Admission

If you are taken to the hospital for a medical emergency, you can pay your hospital expenses and make a claim for reimbursement later if you do not have time to wait for TPA clearance. Alternatively, you can present your health insurance card to the hospital's insurance helpdesk. After noting down your policy number and coverage details, you will be sent an authorization form. To speed up the cashless mediclaim process, fill out the form and submit it.
In both circumstances, the insurance company will cover a portion or all of the costs, depending on the policy terms.

When Choosing A Cashless Mediclaim Policy, Keep These Things in Mind

1. For cashless insurance, your insurance provider should have a relationship with the hospital where you are admitted.
2.  Cashless hospitalization is subject to various limitations that vary by insurance carrier, such as hospital admission fees, ambulance fees, service fees, and so on. Check your pouch documentation thoroughly to ensure that you are aware of all exclusions.
3.  Carefully read your insurance company's policy document to see which ailments are covered by cashless insurance.
4. You may be required to pay co-pay charges to the hospital for each claim under your policy.
5. Your cashless treatment request may be lowered if you are admitted to a room that is not covered by the policy to which you are entitled, subject to the qualifying ward expenses.

Take Away

This is all you need to know about cashless hospitalization and how to get it. To get the best health insurance plan for you, compare policies from several insurers. Before filing a claim, read the terms and conditions of your policy carefully to understand what your insurance company includes and excludes. Keep all copies of medical bills, reports, claim forms, and discharge papers on hand in case you need them to file a claim in the future. With cashless insurance, you can enjoy the benefits of health insurance while also staying financially prepared.

Also Read: Health Insurance Plans By LIC

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.