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Insurance Article

How to Avail Cashless Mediclaim?

January 15 2015
cashless-mediclaim

What is Cashless Mediclaim?

With the entire world going cashless in the form of debit cards, credit cards and cash cards, should not your insurance be cashless too? Cashless mediclaim insurance enables insured patients to avail hospitalization at select hospitals and get treated without settling the hospital bill. The expenses incurred during hospitalization are directly paid by the health insurance company to the hospital.

Benefits of Cashless Health Insurance

  • No cash expenses

    Cashless mediclaim is unlike reimbursement claims where you pay the hospital, only to file for reimbursement of expenses later on. Here, the insured does not pay at all and hence does not have to arrange for short-term funds (from friends or relatives) to meet hospital expenses on an urgent basis.

  • No hassles Hospitalization no doubt can be traumatic. Cashless mediclaim enables the patient and relatives to have peace of mind so that they can focus on the treatment.
  • Less administrative formalities

    Queries in the billing or any unjustified costs are directly taken up by the insurance company with the hospital. Thus, the patient stays out of unnecessary administrative formalities.

Process for Cashless Hospitalization

Cashless hospitalization can either be planned (in consultation with the doctor for an ongoing treatment) or unplanned (during any medical emergency). Find below the process for both:

Planned Hospitalization

  1. Check if the hospital is on the empanelled list of network hospitals
  2. Submit pre-authorization form along with relevant documents to your insurance provider, a few days prior to the hospitalization.
  3. Get treated

    Your mediclaim service provider reviews the documents submitted by the hospital while you are being treated. These include discharge summary, hospital bills, pharmacy bills, investigation reports, payment receipts and doctor's consultation papers. It may request you for a few more relevant documents, if required.

  4. Easy discharge
  5. The claim, if approved, is settled by the insurance company directly. All you need to do is sign on the relevant papers before getting discharged!

    Note:

  1. If your claim is not approved - you may still complete your treatment. You need to clear the hospital dues and may apply for reimbursement claim. Also, remember to obtain your original documents from the hospital.
  2. If a query is raised - by the insurance company, you may need to follow up with them and submit relevant/additional documents required for processing the claim.

Emergency Hospitalization

emergency-hospitalization

The process for planned and unplanned is similar, except in case of an unplanned or emergency hospitalization, the requirement of prior intimation to the insurance provider is waived off. The unplanned process entails:

Cashless mediclaims have emerged as one of the key developments in the health insurance sector over the last decade. With the development of insurance industry in India, more innovations that offer cashless coverage are expected to bring forth a smoother experience to the customer.


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