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Challenges Related To Cashless Treatment

Updated On Oct 26, 2021

Health insurance plans come packed with extensive features and benefits that can be availed by the policyholders at the time of the claim settlement process. At the time of a medical emergency, the policyholders can claim their purchased health insurance plan and avail the accumulated benefits of their plan like pre and post hospitalization costs, room rents, ambulance costs, organ donor expenses, medication costs, no claim bonus, and a lot more. In order to avail the benefits and make a hassle-free claim at the time of an emergency, policyholders can opt for cashless claims at the network hospital of the health insurance provider. Cashless claims can be made at the network hospital of the insurer under which the policyholder need not pay a penny from their pockets for the medical bills. This eases out the entire hospitalization process of the policyholders and ensures them quality treatment without worrying about the monetary constraints.

Challenges Related To Cashless Treatment

Challenges Related To Cashless Treatment

When availing the cashless claim benefits of the health insurance policies, the policyholders can face several challenges that can be avoided if taken into consideration. Let us look at some of the common challenges that are faced by the policyholders in case of the cashless treatments:

1. Lack of Sufficient Knowledge

Sometimes, the claims made by the policyholders are rejected by the health insurance providers due to the lack of adequate knowledge of the policyholders. When making a claim it is important to carefully go through the policy terms and understand the policy clearly, as it avoids any inconvenience at the time of the claim settlement process.

Must Read: Simple Steps To Make Cashless And Reimbursement Claims In Health Insurance

2. Document Related Problems

The cashless claim request raised by the policyholders in case of an emergency can be rejected by the insurers due to lack of proper documents. Therefore, you must keep your claim related documents handy to make a smooth claim. You can get the list of necessary documents under your policy terms or you can also consult your TPA.

3. Exclusions of The Plan

When a claim is made for a medical condition that is excluded within your purchased health insurance policy, then there is a sure chance of the request getting rejected by the insurer. Policyholders must carefully go through the fine print of the policy to understand the exclusions and inclusions of their plan, to avoid any confusion at the time of the cashless claim settlement process. For the process to be quick and smooth, people must not claim for an excluded medical condition.

4. Unavailability of The Cashless Treatment

Sometimes the whole cashless claim procedure can be time consuming due to verification and other proceedings. In such conditions, the policyholders are usually asked to bear the medical expenses and then later the amount is reimbursed into their registered bank accounts. It is always better to consult your TPA in such matters and inform them about your hospitalization as early as possible.

5. Partial Settlement of The Claim

Under certain circumstances, the health insurance provider settles the partial claim of the policyholders in case of a medical emergency, and the other half of the amount is borne by the policyholders themselves. However, later that half amount is reimbursed into the bank account of the policyholders. To get through such conditions, it is important for the policyholders to inform their insurer about the hospitalization as soon as possible, as it can save them a lot of time.

6. Unavailability of Network Hospitals

Cashless claim settlement process of a health insurance policy can be availed only at the network hospital of the health insurance provider. In case of unavailability of the network hospital of the insurer at the time of a medical emergency, the policyholder must bear all the medical expenses at the non-network hospital, which will be reimbursed into their bank accounts. The list of network hospitals of an insurer can be found within the policy documents.


You must consider the above-mentioned challenges at the time of a cashless claim settlement process and then try to avoid them as much as possible. You must carefully read the policy related documents to avoid any confusion at the time of the claiming process.

Also Read: How To Make A Cashless Health Insurance Claim?

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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