Anywhere Cashless in Health Insurance

Friday, Mar 1 2024
Source/Contribution by : NJ Publications

Health Insurance in India is growing widely and rapidly from the last few years. Recently, there has been some very critical reforms that will not only shape the future but also help the present customers to reap the fruits.

Cashless Anywhere is one such reform that will change the entire landscape of Health Insurance claims in India.

Introduction about Health Insurance Claims 

In health insurance, there are two modes of claims - Cashless and Reimbursement. 

So when a health insurance client is hospitalized, the hospital checks whether they can provide cashless treatment to the client. It means the hospital, if under tie-up (agreement) with the insurance company, asks for expenses related to treatment of the client. If the insurance company agrees, the client won't have to pay the hospital for the treatment. This is known as a cashless claim.

Whereas if the insurance company denies or if there is no tie-up with the insurance company, then the customer has to pay the hospital bills from his/her own pocket and afterwards submit the claim forms & bills for reimbursements. This is known as a reimbursement claim.

Today, approx. 55% of clients take cashless claims while the others have to apply for the reimbursement claims. They might be admitted to the hospitals that are outside their Insurance company’s hospital network. This puts a lot of strain on their finances and makes the entire process long & burdensome. It was a necessity to make the whole journey of claims a frictionless process, which will not just improve the client’s experience but will build greater trust in the system.

What is Cashless Anywhere? 

In the case of a hospitalization, currently the facility of cashless treatment is available only at providers (hospitals) where the insurer has an agreement or tie-ups.

As per the directive from IRDAI - all insurance companies are working on to provide cashless claims in hospitals. Niva Bupa Health, Care Health and ManipalCigna Health Insurance Companies are now providing Cashless Anywhere facility to its clients. Some insurance companies have already started such facilities at a few locations and soon will provide it to PAN India. This improves client satisfaction and helps to increase penetration of Health Insurance in India.

Some insurers have a network agreement (tie-up) with about 1000+ hospitals, while some others might have a network of 4000 to 5000 providers (hospitals). But, this is one endeavor where the entire healthcare ecosystem of approximately 40,000 providers (hospitals) can work to give the cashless facility to their clients.

Steps 

  • Inform about the claim to the Insurance Company well in advance. 
  • Incase of a planned hospitalization, inform the insurer 48 hours prior to hospitalization.
  • Incase of an emergency hospitalization, inform within 24 hours of hospitalization.
  • In case the hospital is not under network list, Cashless service is subject to acceptance by the respective health care provider (hospital).
  • In case the hospital is not under network list, Insurance companies may ask the client to take treatment in other nearby hospitals in which cashless is available.
  • Even after putting in all the efforts, if the provider is not accepting an offer by the Insurer and the client is not ready to move to another available provider, the client will have to go for a reimbursement claim.

Claim is not payable incase of treatment in Excluded Hospitals. List of excluded hospitals is available on the respective insurance company’s website.

Summary

With this initiative, clients will be eligible to get treated in any hospital they choose, and a cashless facility will be made available even if the hospital is not in the network of the Insurer.

Aimed at encouraging more clients to opt for health insurance, the initiative also acts as a step towards reducing fraud, which has been plaguing the insurance industry significantly and diminishing trust of the clients.

Once this facility of 'cashless anywhere' works at its best efficiency, clients will benefit the most. 

  • They don't have to worry about arranging money to pay for hospital bills. 
  • They don’t have to run long distances for cashless hospitalization.
  • They don’t have to change hospitals/doctors to get cashless hospitalization.
  • Get access to world class medical facilities.

In short, Clients will be able to reap optimum benefits out of his/her health insurance policy.

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