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Cashless Hospitalization - How It Works

​​​​​Cashless health Insurance plans​ have become major necessity because of the mounting prices of Hospitalisation and reduces the stress on the policy holder of arranging money in case of planned or emergency hospitalisation.

It is of utmost importance to understand how actually the cashless hos​pitalisation ​works and what are the be​nefits available to the health insurance policy holder.

How it works

The first and the foremost important thing to understand is that the cashless benefit is offered only in Network hospitals of the Insurance provider. To put it mildly , the insurance providers tie up with hospitals in a given place by checking the quality of their service, and rates for different procedures they charge for treatment of a patient. Then the providers reach an agreement with such hospitals and the company forms a network of such hospitals for the benefit of the policy holder. And these benefits can be availed by the policy holder for planned or emergency hospitalisation and all the cost incurred for the treatment is borne by the health insurance provider​.​

The major benefit of the cashless health insurance plan in India is that it relieves the stress on the relatives and friends of trying to arrange the money for hospitalisation of the near and dear ones.

So in case of hospitalisation the policy holder is not allowed to pay any thing and the insurance provider which is represented by Third Party Administrator or TPA in short coordinates with the hospital and settles the bill.

Cashless hospitalisation can be taken for planned or Emergency hospitalisation.

In case of Planned Hospitalisation.

Planned hospitalisation is when you have enough time on hand to decide which of the affiliated network hospitals you want to get admitted depending upon the nature of the illness. The most essential part is to make the Insurance provider aware of the nature of illness and get approval for the same from the TPA.

When you go for planned hospitalisation, you have time on hand to fill up the documents essential for admission like preauthorization forms. Once  you fill up such forms , then it has to be submitted at the insurance desk (now every network hospital has a dedicated insurance desk to cater to the needs of the policy holders).  The authorization forms can be obtained for the websites or from the insurance desk in the hospital.

Once you fill the form and submit it, the form gets approved or rejected depending on the basis of the terms and conditions mentioned in the policy. There are many diseases which may not have been covered for the policy holder. 

Once the form is approved then it the job of the Third party administrator to send the sanction letter to the hospital and the treatment can be started thereon.

In case of Emergency Hospitalization.

This is an area where the policy holder has to be little attentive and have to get approval of the cashless scheme within 24 hours of hospitalisation.

The same procedure has to be followed in emergency hospitalisation too of filling up the preauthorization form and getting the approval from the Third Party Administrator. It is mandatory for the TPA to give approval or reject the form within 6 hours in case of emergency hospitalisation so the treatment can go ahead.

In case of emergency, the option available with the policy holder is that the holder can foot the bills of the hospital and then later claim the expenses.