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Insurance Article

Cashless Hospitalisation Facility For Your Health Insurance Claim

May 20 2013
Understanding the Cashless Hospitalisation Facility for Your Health Insurance Claim

Imagine this situation:
Your wife requires emergency hospitalisation. You don't have anything else in mind than rushing her to the nearest hospital. However, the hospital authorities deny admission without a cash payment of a sum evaluated for the treatment.

You inform them that she has health insurance. However, the hospital authorities still demand upfront payment. Now you are left with only one option, which is to rush to the nearest ATM centre to withdraw cash. The ATM too has a limit to the cash you can withdraw within 24 hours.

Somehow, you manage the cash and your wife is admitted. In the next few days, you need to spend more money for an emergency operation, hospital room charges and endless medications. Since you have already withdrawn some cash the day before, you now hastily sell your shares and mutual funds.

Of course, you will get all of the money reimbursed by the health insurance company after you make a claim and submit the bills. However, now you don't have any other option but to exhaust your savings or even liquidating your long term investments, even if for a loss. You end up losing out unless you're the type to hoard heaps of cash in your secret treasure box or under the mattress!

So what's the solution?
  • A cashless hospitalisation facility would have saved you from the hassles.
  • It would have saved your energy as you don't require running from pillar to post to gather cash.
  • It would have saved you from dipping into your current savings.
  • It would have prevented you from selling off long term investments.
Cashless hospitalisation facility is a life saver under emergencies

The facility for getting health insurance claim without paying cash is a boon. Cashless hospitalisation was introduced because insurance companies wanted to help customers in case of emergency. It soon gained popularity across the nation.

The cashless hospitalisation facility can be of great help during emergencies, because this is the time when you don't carry adequate cash for the prescribed treatment. In fact, it is a vital feature of any med claim policy offered in India. Sudden or even planned hospitalisation of a loved one can be disturbing. The rising costs of health treatment have made it tough for people to pay for an unplanned treatment. Under such situations, cashless hospitalisation is a must.

A health insurance provider or their third party administrators (TPAs) usually offer the cashless facility. This allows the insured to receive medical treatment without paying cash.

So is it possible to get treatment at a hospital of your choice ?

This is something most people wish to know when buying a health insurance especially if they have opted for a cashless facility. Well, you may get treatment from your preferred hospital provided it is listed as a network hospital of your health insurance company.

How does cashless hospitalisation works?

Under the cashless facility, the hospital (listed under the network of health insurance for cashless hospitalisation) coordinates directly with the insurance organisation to settle your bills. In some cases, the hospital connects with the TPA.

Hospitalisation - Planned and Unplanned

The cashless facility can be availed under two conditions: planned and unplanned hospitalisation.

Planned Hospitalisation - Here, you have to inform the insurance company or its TPA beforehand about the cause for the hospitalisation.

Unplanned Hospitalisation - In case of an emergency, you may inform the insurance company or its TPA almost immediately after the hospitalisation.

Things to Know about Cashless Health Insurance Facility

The Cashless Hospital List

Since you can avail medical treatment only at the hospital listed under the health insurance cashless network, it is important to have a detailed look at the cashless hospital list before buying insurance policy. This will help you know about the hospitals and medical centres where you can get treatment when required and map the facilities nearer to your home.

The Cashless Cover

Apart from going through the cashless hospital list, you should also know about the expenses that are excluded under cashless facility. These expenses will be borne by you. The key is to study about the exclusions in the policy and applicable conditions in detail so that you are not in for any surprises later.

Understanding your Cashless Facility There are certain things you require keeping in mind when availing of a cashless hospitalisation facility:

  • Not all medical insurance plans come with cashless facility. Hence, prior to assuming you are offered one automatically with a plan, you need to check out with the insurance company about what is offered. Make sure you are offered this policy prior to buying a plan.
  • As discussed already, cashless facility can be availed only at hospitals and medical centres that are networked with the insurance company. Hence, you need to make sure that your health insurance policy covers hospitals near your locality. This especially helps in emergencies when you have to rush the patient for immediate medical attention.
  • It is crucial to know about the health conditions that are exempt from cashless hospitalisation facility. You should learn about these exclusions prior to buying a health insurance plan.
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