An unforeseen medical emergency can mean an unexpected financial burden apart from the emotional stress that such an incident entails. To ensure that adequate financial resources are at our disposal during such emergencies, we sign up for a health insurance policy. However, while this measure affords us some peace of mind, the family of the patient is still required to fill in a plethora of forms and furnish initial amount at the time of hospitalization. Cashless health insurance policies are designed specifically to relieve stress for the insured at the crucial moment of hospitalization.
Cashless health insurance
Cashless health insurance is a policy where the health insurance companies settle the hospitalization and treatment bills directly with the hospitals without the immediate involvement of the insured. Under cashless health insurance scheme, Third-Party Administrators (TPAs) act as the bridge between the insurance companies and the hospitals. All the medical bills raised by hospitals are sent across to TPAs who then coordinate with the insurance companies to settle the claim. This process minimizes the need to furnish any amount at the time of hospitalization and also minimizes documentation required to avail medical services.
Cashless mediclaim service can be of two types:
• Planned claim – When the insured is aware of the hospitalization in advance
•Emergency claim – When immediate hospitalization is required due to serious illness or an accident
Cashless claim settlement process
Every health insurance company offering cashless insurance has a tie up with a number of hospitals which fall under their PPN (Preferred Provider Network). Cashless facilities can be availed at any hospital falling in the PPN of your insurance company.
To avail these services, the insured is required to fill a form furnishing the details required by the hospitals. This form is shared with TPAs, who depending on the terms of policy, would share the limit of expenses covered under the policy and accordingly issue an authorization or denial letter to the hospital. Denial often happens where the required details are not furnished in the pre-authorization form. If the TPA does not approve your request, an alternative could be to pay the bill and reimburse it later. The hospital starts the treatment after receiving the authorization letter from TPAs. At the time of discharge, insurance company processes the claims up to the admissible limits in coordination with TPAs.