The gap between affordability and healthcare costs has steadily increased due to medical inflation. This makes health coverage crucial to bridge fill this void in case of hospitalization due to an accident or ailment.
The number of people choosing this type of coverage is slowly rising. However, many are still unaware of the claim procedure if the need arises. Claims may either be cashless or reimbursement.
A cashless medical insurance claim is available when you seek treatment within the network hospital. The insurer directly settles the hospital bill, which means you do not have to pay anything through your resources.
If you are treated in a non-network hospital, you will have to pay the bill from your pocket. You may then file for a reimbursement claim under your health insurance plan. You will have to submit certain documents, such as the invoice copy, discharge papers, and diagnostic and investigative reports along with the claim form.
Benefits of cashless claims
When you compare mediclaim policies claim procedures, cashless is more convenient and hassle-free. Here are some advantages of cashless claims:
- You do not have to worry about finances while dealing with the emotional pressure of hospitalization
- You are financially protected, as the insurer instantly takes care of the hospital bill
- You can focus on seeking the best quality treatment within the network hospital
- You have the facility to choose from a wide network of hospitals
Procedure to file cashless claims
Generally, you may think that cashless claims work for planned hospitalization; however, it is available even for emergencies. Here is the procedure to file a cashless claim under medical insurance:
- Acquire pre-authorization from the insurer for planned hospitalization, which includes providing the treatment plan and related expenditure to the insurance company
- Provide documents, such as pre-authorization letter, Permanent Account Number (PAN) card or Aadhar Card, insurance company ID card, and a copy of the insurance policy to the hospital
- Instruct the hospital to send all treatment-related documents and the bill to the insurer, once you are discharged
If you need to be hospitalized due to an emergency, you may contact your insurer within the stipulated period to avail of the cashless facility.
Although cashless claims are more convenient, reimbursement claims are also a good option if you want to get treated in a non-network hospital. However, it involves a tedious process and requires you to retain all original documents after discharge to ensure your claim is settled. This is why cashless claims have the edge over reimbursement claims.
If you are not satisfied with your current health insurer, you can check out different mediclaim policies offered by other insurance companies, and opt for a suitable type of claim procedure, as per your convenience, in case of a medical urgency.