Challenges of Cashless Health Insurance – All you need to know

By: |
October 28, 2021 4:23 PM

The coverage offered by these policies helps one overcome the expenses that otherwise would have to be paid out of their pocket.

Health Insurance, insurance claim, death in hospital, max bupa, health insurance claim request, cost of hospitalisation, Covid-19 pandemic, how to make claim request, cashless claim, reimbursement claim, senior citizen day 2020, when is senior citizen day, happy senior citizen day, lic senior citizen pension scheme 2020, world senior citizen day 2020, senior citizen saving scheme 2020, senior citizen saving scheme interest rate 2020, senior citizens health plans, senior citizens health insurance,These procedures are easier than the reimbursement policies as the policyholders do not have to pay anything from their pocket and hence, do not have to stress about the reimbursement process.

The pandemic has been an eye-opener for people and most since then have started opting for insurance, especially health insurance. Medical expenses have also been spiking for the past few years. Along with that, it is difficult to ignore the inflated medical bills that have been visible during this ongoing pandemic. Under such situations, having a health insurance policy comes to one’s rescue as it keeps one financially equipped during any medical emergencies.

The coverage offered by these policies helps one overcome the expenses that otherwise would have to be paid out of their pocket.

Another significant benefit of such policies is the cashless option. With this policyholders get to avail cashless treatments without having to pay any medical bills, depending on the type of policy. The insurance companies partner with specific hospitals also known as network hospitals, and when the policyholders visit these hospitals, the medical bills could be settled without paying anything.

Note that these procedures are easier than the reimbursement policies as the policyholders do not have to pay anything from their pocket and hence, do not have to stress about the reimbursement process.

Having said that, these policies come with their own set of merits and demerits:

  • Claim settlement – Partial claim settlement is one of the biggest problems with the cashless option. It is seen in certain situations, the insurance company pays only for a specific portion of treatment cost as cashless settlement. Some insurers also offer to make a portion of a claim cashless and reimburse the pending amount later. In that case, policyholders will have to immediately pay the pending amount from his or her pocket and later get it reimbursed from the insurance company.
  • Cashless-treatment hospitals – To avail the benefit of cashless treatment, one needs to visit a networking hospital. Hence, experts suggest one should keep a note of all the network hospitals near their vicinity so that there is no confusion during any medical emergency. If one is not able to find any networking hospital or the hospital needs additional time to process a cashless claim, then the policyholder has to bear the cost and later get the amount reimbursed from the insurer.
  • Documentation – Pulling out certain documents can be sometimes daunting in a hospital. Additionally, failing to provide the required documents on time could be problematic during the claim process.
  • Duration for the process – Especially during an emergency case settling cashless claims could be a challenge. Some hospitals take longer for the entire approval process, which could lead to a delayed treatment process. To avoid any delays the hospitals/doctors might ask the policyholders to make the payments of the medical bills from their pocket and later get it reimbursed from the insurance company.
  • Exclusions under cashless claims – Certain treatments are excluded under cashless claims, which also vary from policy to policy. For instance, charges for documentation, regular check-up expenses, service or registration charges, separate medical tests, etc. are not covered under cashless claims. Hence, experts say policyholders should be aware of the policy’s inclusions and exclusion to avoid any surprises later during the claim process.

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