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Challenges of Cashless Mediclaim

Published On Jan 03, 2022

With the rising expense of treatment, it is now more important than ever to invest in quality health insurance policies. It assists in maintaining personal wellness and setting the road for a stress-free existence. Medical insurance allows the insured to receive high-quality medical care at the best facility. It's an optional benefit that provides complete coverage.

In the case of a medical emergency, a cashless mediclaim coverage can let you relax by providing total financial support. It's a lot easier than dealing with reimbursements, where you have to pay for your medical expenses first and then wait for your insurance provider to reimburse you. To know more about the challenges faced in cashless mediclaim, read on.

Challenges of Cashless Mediclaim

Challenges Faced In Mediclaim Policy

Following are the challenges faced in mediclaim policy -

  • Unavailability of network hospitals - You must be admitted to a network hospital to be eligible for the cashless mediclaim plan. Many times, the policyholder is unaware of the hospitals that have been approved to provide cashless services. This is extremely dangerous in medical crises.
  • Partial claim settlement - The insurer may only settle a portion of a claim as cashless, with the remaining amount held for reimbursement later. In this case, the policyholder will have to pay the remaining sum out of pocket and will be repaid later.
  • Cashless mediclaim is not always available - In most emergency situations, TPA clearance is necessary to permit cashless mediclaim. In these circumstances, the TPA will need time to complete the claim. As a result, the insurer may require the policyholder to bear the expense at first and then refund the policyholder later.
  • Exclusions - There are a number of treatment costs that are not covered by medical insurance. Registration or entry fees, visitors/attendant fees, costs for meals, toiletries, paperwork fees, service fees, routine medical check-ups, dental procedures, inherited illnesses, experimental therapies, and so on are all examples of these fees. As a policyholder, it is critical that you read the terms and conditions of the insurance before purchasing it.
  • Problems with documents - The policyholder must complete the pre-authorization form with all of the needed information in order to get cashless treatment. It must be sent to the hospital's insurance department after properly filling out the appropriate information. Frequently, the policyholder fails to comply with this obligation, causing problems with the cashless claim.
  • Insufficient knowledge - The lack of appropriate expertise is another difficulty that clients encounter. Many times, corporations do not sufficiently disclose information or there are discrepancies in proposal forms. Though the services vary from TPA to TPA, claims are frequently denied owing to a lack of understanding.

Through the help of the following steps you can tackle challenges with cashless mediclaim policy -

  1. To assure cashless settlement, check the list of network hospitals and get admitted to one.
  2. When submitting a cashless claim, you must complete a pre-authorization form. If the pre-authorization is not received in a timely manner, the claim may be denied. In an emergency, the paperwork should be filed within 24 hours of being admitted to the hospital. The paperwork should be filed 4-5 days ahead of time for anticipated hospitalisation.
  3. For identification purposes, keep your health insurance card with you at all times.
  4. The policyholder must review the list of treatments and costs that are not eligible for a cashless claim. To make the best decision, compare the terms and conditions of numerous insurance.


Cashless health insurance, when utilised wisely, may be a blessing. To gain the benefits of a cashless settlement, you, as a policyholder, should take preventative precautions and strive to conform to the criteria. Many insurers are offering attractive incentives like minimal paperwork, fast renewal, tax advantages, and so on. To get the finest care at the hospital of one's choosing, one can purchase a plan with these advantages and cashless-related features.

Also read - Importance of Getting Health Insurance That Covers Home Treatment

Benefits of Buying Health Insurance For Diabetics

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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