All You Need to Know about Cashless Hospitalization in Health Insurance

The emotional stress experienced in the event of hospitalization, whether due to a sudden emergency or for a planned procedure, is considerable. Add to it the financial trauma of handling hefty medical bills and admission costs, and arranging for optimal funds - the hassles compound. Dealing with associated financial stress becomes manageable when you have the right health insurance policy.

Health insurance plans offer cashless claim settlements which are a readymade solution for your financial troubles involved with hospitalization. Let’s understand how:

What is Cashless Hospitalization?

Cashless hospitalization is when your insurance company handles your hospital bills directly. You do not have to bear the costs yourself. You can conveniently secure admission without making any payment upfront to the medical facility. Instead, the insurer settles the bills directly with the hospital, thus sparing you from the financial trouble.

Cashless hospitalization is available at Insurers’ Network Hospitals. Insurance companies have tie-ups with hospitals across India to offer cashless admission and treatment facilities to their customers. So, you can avail of the cashless hospitalization facility if you seek treatment at a network hospital.

Benefits of Cashless Hospitalization

Cashless Hospitalization is a beneficial feature on several parameters, which are –

1. Convenience
   At the time of admission to a hospital, you are often required to make deposits with the hospital for potential treatments and boarding expenses. In the absence of the cashless facility you face the burden of paying the deposit yourself.
   
   However, with the cashless feature, these troubles are eliminated. You just need a cashless approval from the insurer and have to present your health card for quick admissions and treatments.
2. Financial Relief
   By handling your medical bills directly, the cashless mediclaim policy alleviates any financial trouble that you might face in paying for the expensive hospital bills and organizing funds while having to prepare mentally and physically for the scheduled procedure.
3. Access to Quality Healthcare
   The cashless facility ensures that you can easily afford good quality treatments at a reputed hospital that is associated with the insurer. 
4. Ease of Health Check-ups
   Many health insurance plans allow free health check-ups during the policy tenure to help you monitor your health. These check-ups are usually conducted at network hospitals and may also be cashless in nature. So, by choosing the cashless facility you can also avail of free medical tests and diagnostics at a hospital nearest to your location.

How to get Cashless Admission in a Network Hospital?

The first requirement for a cashless admission is to locate a network hospital that you prefer. This should, ideally, be done at the time of buying the health insurance plan so that you know which hospitals in your area would provide you cashless treatments in contingencies.

Once you know the network hospital wherein you would avail treatments, the next stage is admission. The admission formalities depend on the type of hospitalization and treatment – emergency or planned. Let’s elaborate –

1. Planned hospitalization
   A planned hospitalization is one that is scheduled in advance. In such cases, you need to obtain cashless approval from the insurer in advance. A pre-authorization claim form should be filled and submitted detailing the type of treatment needed. You should submit this form at least 4-5 days before the intended date of hospitalization. The insurer would verify the form and give you an approval for cashless claims if the treatment is covered under the scope of the policy.
2. Emergency or Unplanned Hospitalization
   Emergencies cannot be predicted and so, hospitalization for the same is not planned. If you suffer an accidental injury or an illness and you need immediate hospitalization, you can seek immediate cashless admission in a network hospital. In these cases, you need to fill and submit the pre-authorization claim form within 24 hours of hospitalization to seek cashless approval in a network hospital. For treatment in a non-network hospital, you would have to pay the amount upfront and then claim it as a reimbursement.

Under either of the case, however, you would have to provide your health card at the time of admission. The health card, issued with your health insurance policy, helps the hospital establish your identity for cashless admissions.

How to get cashless claim settlement?

Once you are hospitalised on a cashless basis, your hospital bills would be handled by the insurance company. You can directly coordinate the claim with the insurer or use the services of a TPA (Third Party Administrator).  All you need to do is submit the necessary documents at the time of hospitalization and the rest of the procedure would be handled by the hospital on your behalf. A copy of all documents submitted to the insurer along with your claim settlement letter would be provided to you along with discharge summary at the time of your discharge. The letter would clearly specify how much claim has been settled and mention the exclusions as well, if any.

Documents Required for Cashless Hospitalization Claim Settlement

The exact list of documents required would be specified by the insurer and would be mentioned in the pre-authorization form. A general list of documents required are as follows:

To be provided by you:

1. Claim form - duly filled and signed – which the hospital provides
2. Pre-authorization form (in case of planned hospitalization)
3. Policy number/ Health card
4. Insured and policyholder’s KYC documents (Identity and Address proof – for example, Aadhar Card, Voter’s ID, PAN Card)

SANA.Insure offers you complete claim support when you suffer medical contingencies. You can just inform SANA.Insure of your claim and we would offer our expert assistance to help you tide over the difficult times easily. Just call us at 011- 411 – 82827 or send us a WhatsApp at 8278271818 and we would assist you get your cashless claim handled and settled without a fuss! Please visit health insurance claims for more information on claims management.

Log on to SANA.insure for information on numerous health insurance plans available in the market, and for a list of insurer network hospitals that offer cashless hospitalization facility. Should you need any assistance, please get in touch with us over WhatsApp chat on 8278271818 or call us on 1800 202 8118 to connect with a Health Insurance Expert at SANA.Insure.

Wish you a healthy and happy life!