Amit’s father suddenly suffered a heart attack one day and it was advised by his family physician that his father should be hospitalized immediately. However, there was one problem… the cost involved in this sudden hospitalization.
Since Amit was the owner of a small startup business, his financial status was a matter of concern. Luckily, Amit’s father had health insurance with an insurer which gave him access to a good spread of network hospitals. As a result, he could avail the benefit of the cashless claim facility at any of these hospitals.
Explained below are details regarding the cashless facility, which is rapidly gaining popularity, owing to insurers’ efforts to expand their hospital network.
What is cashless claim facility?
Cashless claim facility is a benefit given by an insurance company to its health policyholders. This facility enables the insured to get hospitalized at any network hospital of the insurer, without having to pay the hospitalization charges. This relieves the policyholder of a major financial burden, especially with the rising cost of medical care these days. This facility is offered by virtue of the insurer’s tie-up with the hospital, and such hospitals are called network hospitals. The costs usually covered under the cashless claim facility are- hospital room rent, doctor’s charges, cost of medicines, treatment cost, which are referred to as admissible expenses.
Usually, in order to avail of the cashless facility, you would need to go through a Third Party Administrator (TPA), who is an intermediary between the insurer and the hospital. However, some insurers such as Bajaj Allianz have their own in-house team to handle all health insurance cashless claim procedures. You can contact the insurer directly on their toll-free number, who would guide you on the process to be followed with the hospital.
Availing of the Cashless Facility
The cashless facility can be availed by all health policyholders- whether it is an individual policy or a group policy- as long as they have a hospitalization plan. All that is required by the policyholder is that he/she flashes the health card at the concerned network hospital. Make sure that you are aware of the nearest network hospital, by checking with your insurer.
Since the cashless facility can be useful during both planned and emergency hospitalization, it is important to keep in mind that in case of a planned hospitalization, you must inform your insurer or TPA at least 3 days prior to hospitalization. In case of an emergency; the same must be done within 24 hours of hospitalisation. This step is important so that the pre-authorization approval can be done well in time. This pre-authorization procedure is necessary to ensure that you can avail of the cashless procedure. To ensure that this approval process is smooth, provide the hospital with all relevant details about the patient and the policy details, which the hospital would be sharing with the insurer alongwith the treatment details.
In order to avail of the cashless facility, the procedure that needs to be followed is as below.
1. When the customer approaches the network hospital, the hospital verifies the customer details with the insurer by means of a pre-authorization letter.
2. The insurer then verifies details such as policy number, benefits, etc., and sends it back to the hospital.
3. If the insurer approves the cashless facility request, the hospital proceeds with the treatment. However, in case of any denial, there could either be a query, or the customer may have to pay for the required treatment on his own. He/she can submit bills to the insurer for reimbursement. If the claim is admissible, it will be processed/settled as per policy terms and conditions.
Benefits of the cashless facility
The cashless claim facility comes with several benefits. Some of them are:
Savings - The biggest advantage of the cashless facility is that you don’t have to make any major payments towards the hospitalization from your own pocket, except the non-admissible charges, such as all non-medical expenses, service charges, administration charges, registration charges, private nurse expenses, telephone calls, laundry charges, etc.
In addition, availing the cashless facility will also help you save on the sum insured of your health insurance policy. This is because the insurers have negotiated rates for various treatments and services, as a result of the tie-up.
Quality treatment – Since most insurers are tied up with some of the best hospitals in their respective cities, policyholders can be assured of quality treatment. It is, therefore, recommended that you check with your insurer about your nearest network hospital by either calling on the toll free numbers provided by the company or visiting the company website.
Hassle-free procedures – Another advantage that the cashless facility comes with is that of hassle free procedures. Not only does the cashless facility provide you with financial relief, it also enables smooth functioning in terms of documentation, especially since all coordination takes place between the hospital and your insurer.
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