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How Does Cashless Hospitalization Work?

Updated On Apr 15, 2022

Limited health insurance coverage, increased treatment costs for chronic diseases such the coronavirus, cancer, diabetes, and heart disease, and poor government investment in healthcare are some of the reasons behind this. In the case of a medical emergency, a patient must not only deal with physical and emotional suffering but also the financial burden of quickly accumulating adequate finances to meet hospitalized charges. A cashless mediclaim coverage might help you avoid long ATM queues for cash payout or depending on family for assistance in such a situation.

Cashless Hospitalization

The Insurance Regulatory Authority of India (IRDA) set up a cashless hospitalization system in 2002. Cashless therapy is available to those who acquire health insurance through a third-party administrator. It is only accessible at select hospitals that are part of the insurer's network of facilities, as mentioned in the policy document, and is subject to certain restrictions. A cashless mediclaim coverage saves the inconvenience of paying the hospital upfront when you arrive. At the same time, you can be certain that you will receive the best medical treatment possible at the best hospitals, with cashless hospitalization and adequate insurance coverage.

What Is Cashless Hospitalization and How Does It Work?

Let's take a look at how you may utilize this cashless mediclaim service now that you know what it is.

1. Intentional hospitalisation

Assume you or a member of your family will require minor surgery and will be admitted to a hospital. You must tell your insurance carrier in advance of any cashless treatment by completing a pre-authorization form accessible on the TPA website or at the hospital insurance desk. The concerned physician must also complete the form. This form is then sent to the hospital's insurance helpdesk, where it is double-checked before being passed to the TPA, who double-checks the information. Once this is done, the amount is sanctioned, and the hospital receives a cashless mediclaim authorization.

2. Admission To A Hospital In An Emergency

If you are rushed to the hospital for a medical emergency and do not have time to wait for TPA clearance, you can pay your hospital bills and submit a claim for reimbursement later. Alternatively, you can show your health insurance card to the insurance helpdesk at the hospital. A permission form will be provided to you when you have written down your insurance number and coverage information. Fill up and submit the form to expedite the cashless mediclaim procedure. Depending on the policy conditions, the insurance provider will cover a portion or all of the costs in both cases.

3. Keep These Things in Mind When Choosing A Cashless Mediclaim Policy

Your insurance company should have a relationship with the hospital where you are hospitalized for cashless insurance.
Cashless hospitalization is subject to several restrictions that vary by an insurance company, including hospital admission costs, ambulance fees, service fees, and so on. Examine your bag paperwork carefully to make sure you're aware of any exclusions.
To find out which conditions are covered by cashless insurance, examine your insurance company's policy paperwork carefully.
For each claim under your coverage, you may be forced to pay a co-pay to the hospital.
If you are admitted to a room that is not covered by the insurance to which you are entitled, your cashless treatment request may be reduced, subject to the qualifying ward fees.

Take Away

This article will teach you all you need to know about cashless hospitalization and how to apply for it. Compare policies from several insurers to get the best health insurance plan for you. Before submitting a claim, read your policy's terms and conditions carefully to understand what your insurance provider covers and what it doesn't. All copies of medical bills, reports, claim forms, and discharge documents should be kept on hand in case you need to submit a claim in the future. You may get the benefits of health insurance while keeping financially prepared with cashless insurance.

Also read- Everything We've Learned About The Omicron Variant Thus Far

Everything You Need To Know About The Omicron Variant And Kids.


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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