We live in an uncertain world. Nobody knew that a pandemic would cause a health emergency that would put the whole world on pause. And in all this uncertainty, health insurance has become essential for everyone. However, the process of getting reimbursement from the insurance company may be long and stressful for some. Therefore, to suit the changing environment and needs of people, many insurance companies have started providing cashless health insurance.
This option enables the insured to go through their treatment without worrying about the financial strain and paying their bills. The insurance company handles it all!
You may ask what a cashless claim is. And if it is better than reimbursements. How do they differ? In this blog, we have provided the answer to all these questions and more. Read on to learn more.
What are cashless claims?
A cashless claim is an incredibly convenient facility offered by health insurance companies. Under this, you can get your treatment at a hospital in the insurer’s network without having to worry about handling bills. Your insurer will directly deal with the hospital and settle the treatment bills.
How do cashless claims work?
To avail cashless claim facility at the hospital, you have to submit your insurance card and ID proof. The process of claim approval may differ from insurer to insurer. However, the typical process is as follows –
- Inform the insurance desk at the network hospital you are getting treated for the cashless claim.
- The insurance desk will contact the insurance provider with your request.
- Upon approval, your insurer will settle the bills.
If your insurance company doesn’t have an in-house settlement team, you will have to share the necessary form with the TPA. TPA or third-party administrator handles the interactions between the hospital and your insurance provider.
In case of planned hospitalisation, remember to inform your insurer at least 72 hours earlier. In case of an emergency, you must inform your insurer within 24 hours of admission.
Pros of cashless claims
- Cashless health insurance claims allow for convenience and hassle-free processes.
- Hospitalisation can be stressful. With a cashless claim, you won’t have to worry about financial decisions and paying bills. You can focus on getting better.
- It requires minimal documentation.
Cons of cashless health insurance
- To avail cashless claim facility, you can only go to a hospital that is part of your insurance company’s network.
- You have to get the insurer’s approval before starting the treatment.
What are reimbursement claims?
In reimbursement claims, you are free to choose any hospital and get treated. You will have to pay out of your pocket initially and you can get the reimbursement from your insurance provider later. However, you have to submit the invoices and all the required forms to your insurance provider to get reimbursement for the same.
How do reimbursement claims work?
To get reimbursement from the insurance company, you must keep all the documents safe. While document requirement varies from one insurer to another, here are the documents typically required.
- Duly filled claim form
- Invoices and receipts from the hospital
- Receipts and prescriptions from doctors
- Copy of PAN card
- Invoices for tests done
- Diagnosis certificate
You have to submit all the necessary documents to your insurance provider within a certain time limit. Once your claim request is approved, your money will be reimbursed.
Pros of reimbursement claim
- This type of claim provides you greater flexibility while choosing a hospital.
- You do not have to get approval from the insurance company before starting the treatment.
Cons of reimbursement claim
- The reimbursement process takes much longer to process due to document verification.
- The process is complex as you have to save all the invoices and prescriptions to apply for a claim.
- You have to pay the hospital from your pocket.
Difference between cashless and reimbursement claims
|In a cashless claim, the insurer pays bills directly to the hospital.
|In reimbursement claims, you have to pay the hospital out of your pocket. To get reimbursement from the insurance company, you have to submit documents and wait for the claim to be approved.
|Here, you must visit a network hospital and inform the insurer about the treatment to get it approved. After that, fill out the necessary forms and also share them with your insurer. The insurer will settle the claims.
|In this, fill out the necessary forms and submit your bills and other documents to the insurer after getting your treatment done. The insurer will process the claim and you will receive the reimbursement once done.
|Types of hospitals
|To get a cashless claim, the hospital you get treated in must be a part of the insurance company’s network.
|In this claim, you can go to any hospital.
|You need to get the approval of your insurance company before starting the treatment or hospitalisation process.
|You don’t need your insurance company’s approval before treatment. However, remember to verify whether it is covered under your health insurance or not.
|Since the hospital is a part of the insurance company’s network, it doesn’t take much time to settle the claims.
|This takes much more time than cashless claim settlement because the insurance company has to verify all the documents before approving the claim.
|In this case, you only need to fill in the necessary forms.
|For reimbursements, you have to submit your invoices, prescriptions, and required forms.
|Cashless claims offer less flexibility in terms of the hospitals you can choose.
|Reimbursement claims allow you to have more flexibility over the hospital you want to choose.
|Cashless claims offer more convenience and ease over reimbursements since you don’t have to do anything. The hospital and your insurer take care of everything.
|Reimbursements are typically more stressful since you have to pay out of your pocket first and then interact with your insurer separately.
Now that you know the major differences between cashless and reimbursement claims, you can decide which one you want to avail of. Cashless claims have many advantages over reimbursement. Medical treatments in India can be highly expensive in India. With cashless health insurance, you will not have to stress about paying any out-of-pocket amounts. Irrespective of the type of claim you raise for settlement, your health insurance provider
Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.