Make the most of the cashless claim facility

Cashless claim facility is a benefit given by an insurance company to its health policyholders. With this facility enables,the insured does not have to pay hospitalisation charges when he or she is hospitalised at any network hospital of the insurer. This relieves the policyholder of a major financial burden. This facility is offered by virtue of the insurers tie-up with the hospital,and such hospitals are called network hospitals. The costs usually covered under the cashless claim facility are- hospital room rent,doctors charges,cost of medicines,treatment cost,which are referred to as admissible expenses.

Usually,in order to avail of the cashless facility,you would need to go through a Third Party Administrator TPA,who is an intermediary between the insurer and the hospital. However,some insurers have their own in-house team to handle all health insurance cashless claim procedures. You can contact the insurer directly on their toll-free number.

Availing the Cashless Facility

The cashless facility can be availed by all health policyholders whether it is an individual policy or a group policy as long as they have a hospitalisation plan. All the policyholder has to do is flash the health card at the concerned network hospital. Make sure that you are aware of the nearest network hospital.

Since the cashless facility can be useful during both planned and emergency hospitalisation,it is important to keep in mind that in case of a planned hospitalisation,you must inform your insurer or TPA at least 3 days prior to hospitalisation.

In case of an emergency,the same must be done within 24 hours of hospitalisation. This step is important so that the pre-authorisation approval can be done well in time. This pre-authorisation procedure is necessary to ensure that you can avail of the cashless procedure. To ensure that this approval process is smooth,provide the hospital with all relevant details about the patient and the policy details,which the hospital would be sharing with the insurer along with the treatment details.

In order to avail of the cashless facility,the procedure that needs to be followed is as below.

1. When the customer approaches a network hospital,the hospital verifies his details with the insurer by means of a pre-authorisation letter.

2. The insurer then verifies details such as policy number,benefits,etc.,and sends it back to the hospital.

3. If the insurer approves the cashless facility request,the hospital proceeds,with the treatment. However,in case of any denial,there could either be a query or the customer may have to pay for the required treatment on his own. He/she can submit bills to the insurer for reimbursement. If the claim is admissible,it will be processed/settled as per policy terms conditions.

Benefits

Savings: The biggest advantage of the cashless facility is that you dont have to make any major payments towards the hospitalisation from your own pocket,except the non-admissible charges such as all non-medical expenses,service charges,administration charges,registration charges,private nurse expenses,telephone calls,laundry charges,etc.

In addition,availing the cashless facility will also help you save on the sum insured of your health insurance policy. This is because the insurers have negotiated rates for various treatments and services,as a result of the tie-up.

Quality treatment: Since most insurers are tied up with some of the best hospitals in their respective cities,policyholders can be assured of quality treatment. It is,therefore,recommended that you check with your insurer about your nearest network hospital by either calling on the toll free numbers provided by the company or visiting the company website.

Hassle-free procedures: Another advantage that the cashless facility comes with is that of hassle-free procedures. Not only does the cashless facility provide you with financial relief,it also enables smooth functioning in terms of documentation,especially since all coordination takes place between the hospital and your insurer.

Author is Head-Health Administration Team,Bajaj Allianz General Insurance