Cashless Health Insurance
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Livewell: Health Insurance & Wellness Blogs | Max Bupa

Cashless Health Insurance

01 August 2019

Cashless Hospitalization – Health Insurance

 

Cashless hospitalization is an important factor, which you need to consider when purchasing health insurance. Medical insurance is important for all individuals, noting the rising costs of medical care. In addition, today medical treatment costs have reached the highest of all times, and are expected to increase further. Diseases and ailments, as well as accidents, can strike anyone at any given point of time. It may emotionally and financially devastate a patient's family. Although coverage cannot be made for emotional damages, financial losses can be covered by a health insurance policy.

 

Cashless health insurance is one of the most necessary aspects of a health insurance plan, and most health insurance firms offer cashless hospitalization to its customers. Insurance providers in India generally have tie-ups with a given number of hospitals around the country to provide this service to everyone. In cashless hospitalization, all of the medical expenses covered in the insured's policy are settled directly by the provider with the hospital. The process takes place with the assistance of the third-party administrator (TPA), which the companies hire to help them during claims. The insurance holder needs to submit the medical documents to the TPA to successfully file the claims. Then, the claim is set to be approved by the medical insurance provider after reviewing by the TPA.

 

Although the TPA is hired for the health insurance company's convenience, the process of filing a claim is generally delayed due to the TPA. To avoid this hassle and others, some medical insurance providers directly settle claims without any TPA mediation.

 

It is always good to undergo treatment in hospitals, which are under the list of cashless health insurance providers. During cashless health insurance, most of the treatment costs are settled by the health insurance provider directly, without letting the insured shell out any money from his/her pocket.

 

During treatment in hospitals that do not provide cashless health insurance hospitalization, all of the medical expenses are to be borne by insured customers and later reimbursed by his/her health insurance provider. In addition, the health insurance providers do not reimburse treatment costs completely if the treatment is taken from hospitals other than ones in the network. In that case, 80% of the cost is borne by the company. The remaining 20% is to be paid by the insurance holder.