Everything You Should Know About Cashless Medical Insurance

We all are well aware of the fact that medical expenses ruin the financial stability of people in India. According to survey most of the people are forced to borrow money to meet the expenses of treating their loved ones. Sometimes when they find no other way then they have to sell their assets in order to arrange money for the required treatment. In this gloomy landscape of India's healthcare industry, cashless medical insurance plays a vital role. This feature is truly proved to be a boon for common people. Armed with a cashless medical insurance online policy, now you do not have to run from pillar to post to gather hard cash, instead, you can avail the required treatments from a quality hospital without having to spend a rupee from your own pocket. Much to the delight of the policyholders, the provider of the best cashless medical insurance in India settles the bill with the concerned hospital directly. You can avail this cashless treatment facility provided by your cashless medical insurance online only in the network hospitals of your concerned insurer.

What Should You Do to Get Your Health Insurance Cashless Claim Approved?

At the time of admitting in the hospital

  • Hospitalization can either be a planned one or it can be a medical emergency.
  • In the planned hospitalization, you should always need the pre-authorization from the insurer/third-party agent (TPA) in advance before admission. This will ensure that there would be no hassles at the time of admission for doing the necessary paperwork
  • And if it is an emergency hospitalization, the claim intimation must be sent to the insurance company within 24 hours.
  • You should also ensure that the pre-authorization form has been filled up by your treating doctor to make the cashless claims settlement procedure smooth.
  • Apart from the basic details, some of the information that one may share with his/her concerned insurer have to include with policy number, name of the insured hospitalized person, nature of illness or injury, date and time in case of an accident.
  • After being discharged from the hospital, the insurer settles all the bills.

How Long Does It Take to Settle a Cashless Medical Insurance in India Claims?

As per, IRDAI or Insurance Regulatory and Development Authority of India, the insurance company has to settle an insurance claim within 30 days from the date of receipt of the last necessary document. In the case of delay in the payment of a claim, the insurer is liable to pay interest from the date of receipt of last necessary document to the date of payment of claim at a rate 2 percent above the bank rate. However, the insurer may initiate an investigation before paying the claim. Such an investigation has to be initiated at the earliest, i.e., not later than 30 days from the date of receipt of last necessary document. In such cases, the insurer has to settle the claim within 45 days from the date of receipt of the final document.

Why Cashless Medical Insurance Claims Get Rejected?

There are many reasons behind the rejection of cashless medical insurance claims. Following are the most common reasons for cashless medical insurance claims. You should have a look below

  • Sometime the information that the concerned hospitals sends to the health insurance company are not sufficient. For an example, if the attending doctor fails to make a proper diagnosis of the illness, health insurer cannot make decision on the admissibility of Cashless medical insurance online claim.
  • If the health insurance provider receives the pre-authorization letter at the eleventh hour with no adequate time left to check documents, the cashless claim on health insurance plans can be turned down as well.
  • If the policyholders are forced to avail treatments on emergency basis in the nearest hospital which is not in the panel of their chosen health insurance provider, the insurer can rightfully deny the claim for cashless treatments.

Benefits of Cashless Medical Insurance

The benefits of a best cashless medical insurance in India are many.

  • The policyholder does not have to worry about money as the insurance company will settle the hospital bills directly.
  • The patient does not have to retain copies of bills, documents, medical tests and other reports, discharge report, etc. since the hospital settles with the insurance company directly.
  • The insured does not have to run around the get the amount reimbursed after submitting the claims as in the case of reimbursement health insurance policy. All of these facilities and features of cashless medical insurance in India makes life easy for the insured.

Buying a health insurance policy does not mean, you are secured, if you want to keep continuation in policy coverage and enjoy the benefits of cashless medical insurance, you should complete health insurance policy renewal on time.