A cashless insurance policy is the latest addition to the plethora of services provided by health insurance providers. Here are some facts about cashless health insurance to help you choose the best cashless policy.
There are two broad types of health insurance policies:
- Reimbursement insurance policy requires the policyholder to pay the medical bills themselves. The insurance company reimburses these costs later when the insured person files a claim.
- Cashless insurance policy means that the policyholder does not have to pay any bills when soliciting any service from their health care provider. The insurance company directly settles the bills with the hospital or nursing home through a Third-Party Administrator (TPA).
Where can you access cashless insurance policy?
Your cashless health insurance will be valid at any of the hospitals that are a part of your insurer’s Preferred Provider Network (PPN) of health care providers. These select hospitals will be reimbursed directly by your insurer through the TPA. All you have to do after getting to the hospital is present valid documentation for your policy. However, if you go to a hospital outside your insurer’s network, you have to pay the bills upfront and seek reimbursement later.
How does your cashless insurance policy work?
In case of an emergency, here is a step by step breakdown of how you can access the best cashless policy.
- Get admitted to one of the hospitals which is a part of your insurer’s PPN
- Once at the hospital, fill the form for cashless health insurance and produce valid documentation
- This completed form will be sent to the TPA representing your insurer who will issue an authorization or a denial letter to the hospital and also spell out the expense limit for your treatment based on the details of your policy
- The hospital will then start treatment and all your claims up to the admissible limits will be processed by the TPA who represents your insurer
- Benefits of cashless insurance policy
- Cashless health insurance is of great advantage during a medical emergency when you might not have hard cash on you
- It reduces your financial hassles and helps you recover in peace because your TPA mediates to ensure smooth claim settlement
- No hassle over retaining medical bills, test reports and doctor's prescriptions to approach the insurer as soon as possible (usually within 30 days) for reimbursement
- No waiting period between claim and reimbursement. Emergency cases are cleared within six hours and all other cases within four days
Things to keep in mind when availing cashless insurance policy:
- Make sure your preferred healthcare provider is on your insurer’s PPN or that a hospital near you is on the PPN in case of an emergency
- Keep the required documentation for the cashless health insurance on you or in an accessible place at all times. The claim can’t be validated without appropriate documentation