How does cashless mediclaim work?
A health insurance company partners with various hospitals after checking their facilities, doctor's availability, quality of treatment offered. Such hospitals are known as ‘network hospitals’ of that particular insurer. If an insurance company claims to have 10000+ network hospitals across the country, it means you can get cashless treatment in all these hospitals.
How Do You Avail The Cashless Mediclaim Insurance?
As said earlier, you need to first inform your insurer about your hospitalization. After reaching the hospital, you or your family members are required to fill a pre-authorization form. You can get the form either at the insurance desk of the hospital or on the website of your TPA (Third Party Administrator your insurance company has a tie-up with). The TPA will then decide to accept or reject your request for cashless treatment based on the terms and conditions mentioned in the policy wording.
Cashless Treatment Can Be Availed in Two Cases
Planned hospitalization: In the case of planned treatment, you are generally aware that you will get hospitalized in a few days. You need to intimate the insurance company about your hospitalization before being hospitalized. On reaching the hospital, fill the pre-authorization form and submit it to the TPA. Your form will then be checked and verified by the TPA service provider. On approval, the insurance company facilitates cashless treatment to you by paying hospital bills and other expenses related to the treatment. This way, you can avail cashless treatment as per the terms and conditions mentioned in the policy.
Emergency hospitalization: In case of an emergency, the pre-authorization form must be filed within 24 hours of hospitalization by one of your relatives. Your request will then be processed within 6 hours by the TPA. If it gets approved, you won't have to pay anything to the hospital. However, you can also choose to pay in cash and seek reimbursement later if you cannot wait.
In Which Case Is The Claim Rejected?
Almost all the health insurance plans offer a cashless mediclaim facility. But, there are some specific conditions when your health insurance provider may disapprove of your claim. The conditions may be pre-existing illnesses like HIV/AIDS, sleep disorders, sexually transmitted diseases, injuries caused due to self-harm, injuries arising during war or warlike incidents, etc.
FAQs on Cashless Mediclaim
Q 1. How does a cashless mediclaim policy help me?
Cashless mediclaim helps you deal with medical emergencies by paying for your hospital bills. In a cashless mediclaim policy, all the medical bills are directly settled by the insurance company provided the amount falls within the sum insured limit. This leaves the insured tension free.
Q 2. Can I avail cashless treatment in any hospital?
No. Cashless treatment can only be availed at the network hospitals. If you are hospitalized in a non-network hospital, then you will have to pay the hospital bill and file reimbursement claim to the insurer.
Q 3. In how many ways can cashless treatment be availed?
Cashless treatment can be availed in two ways: planned hospitalization and emergency hospitalization. In planned hospitalization, you need to inform the insurer about the hospitalization 24 hours in advance. In emergency hospitalization, you need to inform the insurer 24 hours after being hospitalized. The timing in both cases can vary from insurer to insurer.
It is advisable to read the policy wording to understand the cashless mediclaim facility in your policy. Or give us a call at our toll-free number 7551196989. Our experts will help you file a claim for cashless treatment as well as answer your questions related to health insurance.