Crucial Things to Understand about Cashless Hospitalization

The concept of cashless hospitalization is still unclear to many policyholders of today. It is imperative to understand this feature for everyone can reap the proper benefits of cashless health insurance.

A health insurance plan is a form of security and a stress reliever when it comes to not having to face any hurdles when you or your family member needs hospitalization. Many times it has happened that you get calls from your relatives giving you the bad news that one of your relatives got hospitalized and they need cash. Sometimes you may even be stressing out while rushing to banks and ATMs to withdraw money, in order to pay for the bills because you have not availed or were not eligible for the cashless facility of the policy.

As the name suggests, the Cashless Health Insurance makes the financial dealings such as bill settlements, pre and post hospitalization costs and drugs cost are dealt by the insurance agency and you can focus on the healing aspect. But, the cashless facility is only available at the network hospitals which have the with the insurance agency. This tie-up is done after the insurance company has gone through the medical set up and the facilities offered by these hospitals. With a Cashless Health Insurance plan you do not need to wait for the company to reimburse your expenses as the insurer pays for you, provided the total amount is within your insurance budget. But, there are certain things you need to know about this feature.

There are two types of cashless health policy utilization:

  • Planned Hospitalization where you know you need to be hospitalized and you can check out the network hospitals accordingly. Then, after you finalize the hospital of which you have taken the health insurance policy card to and fill out the pre-authorization form (where the first part is filled by the patient and the latter by the attending physician). This form will be scrutinized for authenticity and then it will be forwarded to the Third Party Administrator (TPA), who will be the mediator between your hospital and the insurance agency, will either approve or reject the claim. If approved, the form will be forwarded to the agency who then will sanction the treatment amount.
  • Emergency Hospitalization, as the name clearly states, is when you need to be admitted immediately. In such a scenario, the Cashless Health Insurance policy benefit initiation should be done within 24 hours of being admitted. In such a situation, you need to provide your insurance card which has the details such as policy number, the name of the insurance company and type of health insurance you have availed to the insurance desk. After filling out the pre-authorization form, the insurance desk will ensure haste claim process and according to protocol, the TPA should process the claim within 6 hours.

Even though a health insurance policy pretty much covers everything, there are few exceptions that have to be paid by the insurance holder like ambulance charges, visitor fees, service charges, toiletries, documentation charges and cost of diapers, oxygen masks, nebulizers, etc.

There are instances when even though you have opted to avail the Cashless Health Insurance cover, your claim can still get rejected. This can happen if the illness for which you are being treated is not covered by the insurance agency or the hospital send incomplete details regarding the treatment even though you have gone for treatment to their preferred hospital.  This occurs especially during emergency hospitalization where it takes time for the doctors to come to any conclusion regarding the ailments and the course of treatment. In such cases, the policyholder pays from their pockets and can later claim the reimbursement.

Being the one who is going to be at the receiving end, for good or for bad, you have to ensure you have read the fine lines. Make sure the insurance offers maximum coverage and the list of preferred networks is long.