A health insurance plan offers two main methods for settling claims: reimbursement claims and cashless claims. In a reimbursement claim, the policyholder initially covers the entire hospitalisation and treatment costs and later submits the receipts to the insurance company for reimbursement. This process may strain the policyholder financially as they must arrange funds upfront. 

Therefore, policyholders often prefer the convenience of cashless claims, where the insurance company pays the hospital directly. Despite its popularity, a cashless mediclaim policy presents its own set of challenges and obstacles. This article explores the concept of cashless mediclaim, delving into its challenges and providing insights on overcoming them.

What is Cashless Health Insurance?

Cashless mediclaim policy means paying for medical expenses without the insured person having to make upfront payments, making the process hassle-free and convenient. In this system, the policyholders can avail themselves of medical services at network hospitals without bearing the financial burden initially. Instead, the insurance provider directly settles the bills with the healthcare facility up to the predetermined sum insured. This streamlined process alleviates the immediate financial strain on the insured and accelerates the treatment process by eliminating the need for reimbursement claims.

Challenges of Cashless Health Insurance

There are certain challenges which should be addressed when talking about cashless health insurance: 

  • Limited Network Coverage: One significant challenge of cashless health insurance is the limited network of hospitals and healthcare providers that accept cashless claims. Policyholders may need help finding nearby facilities within the insurer’s network, leading to inconvenience and potential out-of-pocket expenses if they choose non-network hospitals.
  • Pre-authorisation Process: Cashless health insurance often requires pre-authorisation for planned medical treatments or hospitalisations. Obtaining approval can be time-consuming, causing delays in crucial medical procedures. This challenge may hinder the swift provision of healthcare services, especially in emergencies where immediate action is vital.
  • Claim Denials and Deductibles: Insurance providers may sometimes deny cashless claims or apply deductibles, leaving the policyholder responsible for a portion of the expenses. This can lead to disputes and dissatisfaction among policyholders, as the expected financial relief may still need to be fully realised, impacting the perceived benefits of cashless health insurance.
  • Rising Premiums: As insurance companies expand their network and offer more comprehensive coverage, premiums for cashless health insurance policies may increase. Affordability becomes a concern for policyholders, and some individuals may need help to maintain coverage, particularly if the rising costs outpace their financial capacity. 

How to Ensure a Hassle-free Settlement with a Cashless Mediclaim Policy?

Cashless mediclaim policies are highly advantageous for policyholders as they ensure that the burden of hospitalisation expenses does not occur to the policyholder. The challenges we discussed above can be easily tackled by being aware of the nature and scope of your health insurance plan.

Here are a few ways to tackle the challenges of cashless claim settlement.

  • Check out network hospitals: Before finalising a health insurance plan, go through the list of its network hospitals. Three types of hospitals should be a part of your cashless mediclaim policy’s network:
  • Hospitals in the vicinity for emergency hospitalisation
  • Your preferred hospitals where you generally go for treatments and procedures
  • At least 1 top hospital in your city/region for advanced treatments and procedures

A wide cashless hospital network allows you to avail yourself of the best possible treatment at the hospital of your choice in any part of the country without worrying about expenses.

  • Check the inclusions and exclusions of your policy: Note all the treatments and procedures not covered under your cashless health insurance policy, especially before you plan the treatment or get hospitalised. If the treatment is not covered under your cashless mediclaim policy, you will need enough time to source and get ready with the necessary funds required for the expenses.
  • Get the documents ready: A pre-authorisation form is the most important component of your cashless claim. For emergency hospitalisation, it needs to be submitted within 24 hours of getting hospitalised. The form should be submitted 4-5 days before the hospitalisation for planned treatments.

A proper and complete set of invoices, receipts and bills must be submitted to the third-party administrator (TPA) for seamless and full cashless settlement. Keep the insurance certificate or health card handy and accessible to all family members. Educate your family members as well about the documentation and claim settlement process.

Bottom Line

While cashless health insurance best plan offers a streamlined approach to accessing medical care, it has challenges. Limited network coverage, the intricacies of the pre-authorisation process, potential claim denials, and rising premiums pose hurdles for policyholders seeking a seamless healthcare experience. Addressing these challenges requires a thoughtful selection of insurance providers that address current concerns and anticipate and adapt to the evolving healthcare landscape. 

Hence, we see that choosing a reliable and customer-centric insurer is essential. Niva Bupa, with its commitment to providing comprehensive and accessible health insurance solutions, stands out as a reputable choice. Consider exploring Niva Bupa’s offerings for a healthcare plan that addresses the challenges of cashless health insurance and prioritises individuals’ and families’ well-being and financial security.