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Cashless Hospitalization Vs Reimbursement In Health Insurance

​Medical technology has increased over the last few decades and so does the medical treatment cost. That’s why having an adequate health insurance policy is the need of an hour. And people are understanding this factor and that’s why one can see the gradual increase in the customers buying health covers. However, many people are still unaware of benefits during a claim. Today we are going to talk about the process and methods of filing health claims. Also, we will talk about the cashless and the reimbursement mode. 

Cashless Claims

When you get hospitalized in one of the network hospitals of your insurers, you will be eligible for a cashless claim’s facility. Insured don’t have to pay anything to the hospital as their insurance company will directly settle the hospitalization bills with the hospital. Depending on the terms and conditions of the policy, one can avail of the benefits of a cashless claim facility for both planned and unplanned medical treatments. Given below are the procedure that you need to follow to avail the cashless claims benefit:

For Planned Hospitalization 

  • You need to take a pre-authorization from your insurer, which includes sharing treatment and other expense details with the insurance company. You should take this approval a week before getting hospitalized.​
  • After contacting your insurer, they will ask you to bring some documents that may be required. Documents such as:

  • ​ID card issued by your insurer
  • Pre-Authorization Letter
  • Health Insurance Policy
  • Pan Card, Aadhaar Card/ Form 60

  • After sharing the above-mentioned documents and medical details with your insurer, they will evaluate the treatment details and will inform the concerned hospital.

  • After the completion of the treatment, you need to keep the original bills and treatment evidence with the hospital so that they can directly settle the bill with the insurance company.

  • For Unplanned Hospitalization

    In this case, the insured needs to inform the insurer via the customer care center to know about the network hospitals. You can then opt for cashless hospitalization by providing insurance ID cards and a copy of the insurance policy. 

    Then all steps will be the same as it was in planned hospitalization.

    Reimbursement Claim

    Another way of settling a medical insurance claim​ is by reimbursement mode. This case arises when you decide to choose a hospital that doesn’t come in the insurer’s network hospital. In such a case, you have to make the payment and then you can file the claim for reimbursement. Given below is the procedure that is required to make a reimbursement claim:

  • Firstly, the insurance company will evaluate the documents and then see whether the treatment that you want comes under their health policy or not.
  • You then have to provide necessary documents and hospitalization bills at the time of filing claim. Documents such as: 
  • Claim Form
  • ID Cards 
  • Summary of hospital discharge 
  • Bank details
  • Diagnosis reports
  • Hospitalization and pharmacy bills 
  • Copy of FIR (accidental hospitalization)

  • After submission of documents, your insurer will make payment to the beneficiary as per policy terms.

  • Before you buy health insurance​, you should be aware of what your policy offers.