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What Are The Challenges Related To Cashless Mediclaim?

Published On Jan 25, 2022

With the growing cost of healthcare, it is more necessary than ever to invest in good health insurance plans. It aids in the maintenance of personal wellbeing and the establishment of a stress-free lifestyle. Medical insurance enables the insured to get high-quality medical treatment at the most appropriate institution. It's an add-on benefit that gives you full coverage.

A cashless mediclaim policy might let you relax in the event of a medical emergency by offering complete financial support. It's a lot less complicated than dealing with reimbursements, which require you to pay for your medical bills first and then wait on the insurance provider to repay you. To understand more about the challenges faced in cashless mediclaim, read on.

What Are The Challenges Related To Cashless Mediclaim?

What Are The Challenges Faced In Mediclaim Policy?

Following are the listed challenges faced by people in mediclaim policy -

  1. Inaccessibility of network hospitals - To be eligible for a cashless mediclaim plan, patients must be treated to a network hospital. The policyholder is frequently unaware of hospitals that have been authorised to provide cashless treatments. In medical emergencies, this is exceedingly harmful.
  2. Limited claim settlement - Only a fraction of a claim may be paid out in cash, with the remainder kept for payment later. In this situation, the policyholder will be responsible for paying the balance out of pocket, which will be reimbursed later.
  3. Cashless mediclaim is not always accessible - To allow cashless mediclaim in most emergency scenarios, TPA certification is required. In these cases, the TPA will want more time to finalise the claim. As an outcome, the insurer may ask the policyholder to pay for the expenditure up front before eventually refunding the policyholder.
  4. Prohibitions - Medical insurance does not cover a lot of fees associated with treatment. These prices include registration or admission fees, visitor/attendant fees, lunch costs, toiletry charges, paperwork fees, service fees, routine medical check-ups, dental operations, hereditary diseases, experimental therapies, and so on. It is vital that you study the insurance's terms and conditions before acquiring it as a policyholder.
  5. Hitches with documents - To get cashless treatment, the policyholder must submit the pre-authorisation application with all required details. After correctly filling out the necessary information, it must be forwarded to the hospital's insurance department. Oftentimes, the policyholder fails to fulfil this duty, resulting in cashless claim issues.
  6. Inadequate knowledge - Another problem that clients face is a lack of sufficient knowledge. Frequently, firms fail to adequately reveal information or that there are inconsistencies in proposal forms. Despite the fact that the services provided by TPAs differ, claims are routinely refused due to a lack of knowledge.

You can overcome issues with a cashless mediclaim policy by following the procedures listed below -

  1. Check out the list of medical centres and then get hospitalised to one to ensure a cashless settlement.
  2. A pre-authorisation form must be completed when making a cashless claim. The claim may be refused if indeed the pre-authorisation is still not obtained in a timely way. The documentation must be submitted within 24 hours of someone being admitted to the hospital in an emergency. For planned hospitalisation, papers must be submitted 4-5 days ahead of time.
  3. Every individual should always keep their health insurance card with themselves at all times for identification purposes.
  4. The policyholder must look over the list of procedures and prices that aren't covered by a cashless claim. Evaluate the contract terms of several insurance policies to make the best option.


When used properly, cashless health insurance may be a godsend. You, as a policyholder, must take precautionary measures and seek to meet the conditions in order to take full advantage of a cashless settlement. Many insurers are giving enticing incentives like low paperwork, quick renewal, and tax benefits, among others. One can acquire a plan with these benefits and cashless-related features to receive the best treatment at the hospital of one's choice.

Also read - Importance Of Getting Health Insurance Policy Which Covers Home Treatment

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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