Health Insurance, as everyone knows, is a facility wherein the insurance provider charges a premium to the insured in exchange of an undertaking to reimburse the medical expenses incurred by the insured person. There’s no second thought about the fact that investing in health insurance is a necessity in today’s world. A health insurance policy can not only help you get the best medical treatment but also save you from shelling out your hard-earned savings.
A cashless claim facility is offered by many insurance providers today. Earlier, even if you had a health insurance policy, you were still required to pay for your treatment upfront and the expenses were reimbursed much later. Moreover, in case of critical illness, hospitals demand cash before or at the time of admission of the patient. People may have critical illness cover, but not everyone has instant cash ready with them in the event of a medical emergency. Lack of availability of funds has led to the loss of many lives. Despite paying health insurance premiums, people had no access to top medical facilities due to initial payment issues.
Such complications were identified by health insurance providers and the concept of cashless hospitalisation support was introduced. It would not be an overstatement to say that this move has changed the health insurance industry forever.
To pay off the hospital bills instantly, the insurance companies have come up with the system of offering cashless health insurance. It involves no initial advance payment at the time of admission of patients into the hospitals; therefore, there is no subsequent reimbursement. Under this scheme, the medical costs, subject to the maximum of the assured limit, are directly settled by the insurance company. The health insurance-covered patient and their family members need not to worry about the expenses. The only thing they need to do is to buy a health insurance with cashless benefits. They have to choose the right policy with enough assured amount and get an additional critical illness cover if required.
In case of a medical emergency, a patient can get medical treatments under the cashless cover by filling up a pre-authorisation form available at the insurance desk of the hospital or on the official website. The filled form can be then forwarded to the TPA. After a quick review, the patient is allowed to take admission and treatment under the scheme.
There are Two Scenarios
- Planned hospitalization: You are required to fill in the pre-authorisation form prior to your hospitalization date. Also, you need to take your insurance card along. These documents will be checked and verified by the insurance company and then will be forwarded to the TPA, who may either accept or even reject the claim, of course, with some valid reason.
- Emergency Hospitalization: In case of emergencies, the pre-authorisation request should be made within twenty-four hours of admission. Patient’s relative needs to fill in the pre-authorisation form, which will be sent to the TPA online. They will process and intimate the acceptance/rejection within six hours.
The cashless insurance benefit can be availed at network hospitals only. Insurance providers tie up with a network of hospitals after reviewing their credibility, background, their quality, rates, procedures, efficiency, and expertise of the medical professional. These hospitals get reviewed on a regular basis and the tie-ups are renewed based on these reviews. The hospitals that don’t perform well and lose their credibility are removed. Thus, it’s important to keep updating yourself with the list of hospitals your insurance provider has tie-ups with.
Even under the cashless policy, there is a rider. A representative from the insurance company or a Third Party Administrator, usually called TPA, will be there, whose responsibility is to coordinate with the hospital and settle the claims – whether cashless or cash. Only after getting concurrence from the TPA, the admission and other processes start.
When you buy a policy with an insurance provider, they inform you about the things that are excluded from the health insurance benefits. Usually what comes covered in a health insurance plan is written in the policy document. They may cover almost all medical conditions and emergencies; however, there are some common exclusions like pre-existing illness, say AIDS/HIV, illegally caused damages, and non-medical expenses that are not covered.
Buying cashless health insurance is important. In the times of COVID, many people needed instant hospitalisation and the healthcare costs were skyrocketing. Such were the times when one needed the maximum coverage in cashless. Many fantastic schemes such as the corona kavach plan were designed to help people with their quick medical needs. It helped many people and saved many lives.
You have to scout for suitable policies that cover pre-hospitalisation and post-hospitalisation charges, inpatient care and small but important aspects like ambulance charges so that you can be safe at the critical juncture. After buying the policy, the other important aspect is knowing your policy in and out. In addition, their hospital network, the illnesses they cover or don’t cover, and other exclusions of the policy.