Let’s say your loved one has a sudden medical emergency. You bring them to the hospital, and your mind is full of a million concerns for their health. What is the last thing you wanna worry about in that moment of crisis , probably- “How am I going to pay the huge hospital deposit right now?” Having to arrange tens of thousands or lakhs of rupees on the spot is a nightmare no one should ever have to go through.
This is where the magic of the cashless medical insurance plans comes into play. It’s a benefit that takes the financial burden off a medical emergency, so you can concentrate solely on what’s important – the health of your family.
But what is a cashless claim and how does it operate? Is it just that easy, as you might imagine? In this complete guide we will discuss the whole process. In this article, we will throw light on how this wonderful feature of the new age medical insurance functions, its amazing benefit and its status as a must-have in every health insurance plan today.
What is Cashless Health Insurance?
Let’s clear this up first. Cashless health insurance is nothing different, cashless treatment is a facility provided by your health insurance company as part of your policy.
In simple terms, a cashless facility means that if you are admitted to one of your insurer’s approved ‘network hospitals’, you don’t need to pay the medical bills out of your own pocket. The insurance company will pay the eligible costs directly to the hospital.
Consider it as a prepaid contract between your insurer and hospital. You present your health card, you receive the treatment you need and the two institutions take care of the financial part in the background. This is the opposite of a reimbursement claim in which you pay the hospital first and then send the bills to your insurer to get your money back later.
How Does the Cashless Process Actually Work?
It’s important to understand the process in order to use it effectively. The procedure varies a bit depending on whether you are in for a planned or an emergency hospitalization.
Scenario 1: For a Pre-Check Hospitalisation
This is for instances where you know you’ll be going into hospital in advance, for example a planned surgery like a cataract operation, maternity procedures or a knee replacement.
- Select a Hospital (Network): The first step is to select a hospital from your insurer’s network list. This list is readily available on your health insurance company’s website.
- Tell the Insurer: Tell your insurer that you will be hospitalized at least 3 – 4 days before you plan to undergo a surgery.
- Complete the Pre-Authorisation Form: In the hospital you will find an insurance desk or TPA (Third-Party Administrator) desk. You must fill a pre-authorisation form and submit it along with your doctor’s diagnosis and treatment plan. This process is aided by the hospital and sent to the insurer.
- Insurer’s Approval: Insurer will consider the request. After they verify your health insurance policy and the necessity of the treatment, they will send a letter to the hospital that includes the initial amount that they have approved.
- Get Admitted and Treated: With the approval in hand, you can be admitted and get treated without paying any charges for the covered expenses.
- Discharge and Final Settlement: Upon the patient’s discharge, the final bills are sent to the insurer by the hospital. The insurer sends the insured amount directly. You will only be asked to pay for anything that wasn’t covered (like consumables or anything that goes over your policy limit).
Scenario 2: During a Medical Emergency
In an emergency, such as the event of a heart attack or accident, you obviously don’t have time to pre-plan. The process is modified for this urgency.
- Get Patients Admitted Now: The first thing you need to do is to admit the patient to the nearest network hospital. Don’t wait to be treated for paperwork.
- Present Your Health Card: Present your health insurance card or policy number at the insurance desk.
- Inform the Insurer: it is important that you or your family member contacts the insurance company within 24 hours of hospitalisation.
- Pre-Authorisation During Treatment: While treatment is initiated the hospital’s insurance desk will process the pre-authorisation, and dispatch to the insurer for approval.
- Direct Settlement at Discharge: Similar to a planned Hospitalization, the insurer will pay the bill as settled for the treatment at the hospital when the treatment is over.
The Powerful Benefits of a Cashless Medical Insurance Policy
Now that you have learned the mechanism behind it, let’s look at why this feature is so transformative. It’s not just about convenience, the benefits are profound.
Unparalleled Level of Peace of Mind in a Crisis
This is the most important benefit. The experience of a medical emergency is extremely stressful. A cashless facility removes the tension of planning a large amount of cash at the last minute. This mental quietness enables you to be calm and make better decisions about the care of the patient.
Quality Healthcare Accessed Right away
With a cashless facility, you don’t have to compromise on the quality of healthcare because you don’t have immediate cash. You can opt for the best network hospital in your area and make sure that your loved ones receive proper treatment that they deserve without any further time delay. Your medical insurance policy allows you to place health above finances.
Ensures Your Hard Earned Savings Are Protected
One of the primary reasons for health insurance is to secure your financial ambitions. A major hospital stay can deplete your savings, compel you to liquidate assets or leave you in debt. The cashless facility provides a robust financial protection, where your hard-earned money stays untouched and safe for its intended purpose like your child’s education, retirement or a new home.
Simple and Easy to Manage Process
While all this requires some paperwork, it’s much less than a reimbursement claim would be. In a cashless claim, the hospital’s TPA desk does most of the heavy lifting – coordinating with the insurer, submitting documents and following up. You are saved from the tiresome task of gathering all the bills and reports, filling in several forms and then waiting for weeks or months for your money to be given back to you.
Reduces the Chance of Fraud
In a cashless system the health insurance company and the hospital are connected to each other. The insurer looks at the bills carefully in order to settle them. This transparency helps to prevent an inflated bill or unnecessary procedures from happening, and ensures that everyone’s interests are fairly represented.
Final Word
Uncertainties are bound to occur in life’s journey but being caught off guard is a choice. A cashless facility is more than a feature in a policy document; it’s an empowering tool that brings dignity and security during a vulnerable time. It means that in the event of a health crisis, your attention is not directed towards organizing money, but on getting well.
Purchasing the right health insurance plans is one of the most important decisions in your life. It is your family’s financial shield. As you weigh this vital safety net, safeguarding you from the crushing burden of out-of-pocket costs, it is imperative to select an insurance companion that you can depend on. Niva Bupa is keenly dedicated to being that partner, with their extensive number of family health insurance that offer complete coverage over our network of over 10,400 hospitals that continues to expand. Their commitment to streamlined claim processing and a consistently high Claim Settlement Ratio (CSR) stands as a testament to their promise of being there for you when you need us most.
