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Challenges to Cashless Mediclaim Plan

Today, with the increasing cost of treatment, it has become imperative to invest in good health insurance plans. It helps to take good care of personal health and paving the way for tension-free life. With medical insurance, the insured can enjoy quality medical treatment in the best hospital. Under the canopy of health insurance, you can avail hassle-free treatment with the benefit of cashless claims. It is an add-on benefit that gives total protection.

However, there are some challenges related to cashless mediclaim plan:

  1. Unavailability of network hospitals: In order to avail the benefit of the cashless mediclaim policy, you have to be admitted in the network hospital. Many times, the policyholder is not aware of the empanelled hospitals for cashless facility. This proves disastrous, especially in medical emergencies.
  2. Partial claim settlement: Sometimes, the insurer only settles the partial claim as cashless, and the pending amount is kept for later reimbursement. In such a scenario, the policyholder has to pay the remaining amount from his own pocket and get this reimbursed later on.
  3. Cashless facility not available on time: Mostly in emergency cases, the approval of TPA is required to facilitate cashless mediclaim. In such cases, the TPA requires time for the processing of the claim. Thus, the insurer sometimes asks the policyholder to bear the cost at first and then is later reimbursed.
  4. Exclusions: There are various treatment expenses, which are excluded under medical insurance. These include registration or admission fee, visitors/attendant’s fee, charges for diet, toiletries, documentation charges, service charge, routine medical check-ups, dental procedure, hereditary disorders, experimental treatments, etc. As a policyholder, it is imperative that you go through the terms and conditions of the plan while buying the policy.
  5. Document-related issues: For availing cashless treatment, the policyholder needs to fill in all the required details in the pre-authorization form. After duly filling the relevant information, it is to be submitted at the insurance desk at the hospital. Many times, the policyholder fails to adhere to this requirement leading to difficulty in the cashless claim.
  6. Lack of adequate knowledge: Another challenge that the customers have to face is the lack of sufficient knowledge. Many times the companies do not disclose the facts adequately or there is a difference in proposal forms. Though, the services differ from TPA to TPA many times the claim gets rejected due to lack of sufficient knowledge.

Steps to tackle challenges with cashless mediclaim policy:

  • Check the list of network hospitals and get admitted in a network hospital to ensure cashless settlement.
  • Filling of pre-authorization form is mandatory when availing a cashless claim. The claim may be rejected if the pre-authorization is not sent in time. In case of emergency, the form should be submitted within 24 hours of hospitalisation. Whereas in planned hospitalisation, the form should be submitted 4-5 days in advance.
  • Always carry your health insurance card for identification purposes.
  • The policyholder must go through the list of treatments and expenses that are excluded under cashless claim. Compare the terms and conditions of various insurers to finalize the best choice.

Final Words

If used strategically, cashless health insurance can prove to be a bliss. You, as a policyholder, should take the precautionary measures and try to adhere to the requirements to reap the benefits of a cashless settlement. A lot of insurers are providing exciting offers like no paperwork, easy renewal, tax benefits, etc. One can buy a plan with these benefits and cashless-related features to enjoy the best treatment at the hospital of choice. 

Also Read

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