All You Need to Know About Cashless Claim Policy
Published On Apr 15, 2019 5:30 AM By Sakshi Aggarwal
Not putting aside the emotional sufferings, but financial instability for most of us can lead to mental trauma in the event of hospitalization. At this time, health insurance comes to the rescue. A good health insurance overcomes an unforeseen medical emergency that otherwise could have hampered your savings of the entire lifetime. This is a precise explanation of why everyone must invest in health insurance.
While health insurance can get you covered against hospitalization expenses, you still may be asked to pay for it out of your pocket before raising a claim. But this might be a great situation for those without extra savings. This is when cashless hospitalization proves to be helpful.
Cashless health insurance-What does it mean?
With skyrocketing medical expenses these days, health care treatments are becoming more expensive. Unless you are loaded with money, you require full planning to survive through any kind of medical emergency. And your financial plan requires a good health insurance policy that provides a cashless claim settlement facility. It will save you the hassles of paying cash at the hospital and would not face any financial trouble.
So, if you are hospitalized, but don't own sufficient emergency funds to pay off the hospital bills, then cashless health insurance is all that can help. All you need to do is notify your insurer about the illness that you are facing that must be covered under your health insurance plan.
Once the insurance company receives information about your hospitalization, it will directly get the bills settled with the hospital. You won’t be required to pay even a penny as the amount and wait for the health insurance company to reimburse the sum.
The claims process for treatment differs from the type of treatment. It can be planned or non-planned. Unplanned treatment generally happens in the case of an emergency.
The process of the claim for planned treatment at the cashless network
In the case of planned treatment, the insurer should be informed at least 4 days before the treatment date. Request for a cashless claim shall be submitted at the relevant address of the insurer, generally via post, e-mail, or fax. The insurer will then notify the insured as well as the concerned network hospital about the policy cover and eligibility. At the day of hospitalization, the insured individual has to show his/her health insurance card and confirmation letter. The insurer will then pay the medical bills directly to the hospital.
The process of the claim for emergency treatment at the cashless network
- The policyholder has an option to connect with the customer care department of the insurer to get information about the nearest network hospital.
- You can avail the cashless hospitalization by displaying your health insurance card.
- The hospital will fill the cashless claim request form and submit at the relevant address generally via post, e-mail, fax or customer care.
- The insurer will then be issued an authorization letter indicating policy coverage.
- The insurer will pay the medical bills directly to the hospital. If the claim is rejected, the insured will receive a letter stating the reasons.
Documents required for cashless claims
To make a health insurance claim, the following documents are required-
- Duly filled claim form
- Medical Certificate/ Form which is signed by the treating doctor.
- Discharge summary or card (original), availed from the hospital.
- All the receipts and bills in original
- Prescription and memos from pharmacies/ the hospital.
- Investigation report
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Note: In the event of an accident case, FIR or Medico Legal Certificate (MLC) is required. You must also note that GST of 18% is applicable to all financial services with effect from 1st July, 20187. The policyholders are advised to keep a copy of all hospital bills and documents for future reference.