The conventional insurance model works on the reimbursement process where once the emergency arises, the expenses are paid by the insured and later the amount is reimbursed by the insurer against the policy availed by the insured. For instance, when a medical emergency arises, the expenses are borne by individuals which are later reimbursed by the insurance companies. However, there are times when the claims also get rejected if there is even a slight mistake in the paperwork.
This is where cashless claims come into play. Every insurance company has a tie-up with a network of hospitals. You may check the list of hospitals that your insurance company has a tie-up from their website and make sure you get treated in one of these hospitals to get the cashless advantages.
Under this collaboration, the insured person can avail of benefits like cashless claims. Cashless claims enable an insured person to get treated for any emergency medical situation without paying any amount for it. Under this system, the expense is borne by the insurance company. This makes the whole process of claim settlement hassle-free as, during any mishaps like accidents or ailments, the insured can remain carefree when it comes to arranging funds for treatment.
The individual has to follow a set of procedure to avail these cashless benefits under their health insurance policy:
Firstly, there has to be a medical emergency so that the cashless claims service can be availed.
Make sure you are aware of the network of hospitals your insurance company has a tie-up with. When you are already aware of this, it saves you time at the moment of an emergency. You should get yourself treated in one of these hospitals only.
At the insurance desk of the hospital, (there is a corner that deals with insurance claims and cashless claims as well), ask for a pre-authorization form, or if you want to save time for that as well, download it from the Third Party Administrator's website (TPA). TPA is a licensed authority appointed by the Insurance company to carry out the task of providing claim-related facilities to the insured person on the company's behalf.
After you have filled the form, submit it to the insurance desk. After processing, the TPA will send you a confirmation email enlisting the maximum amount sanctioned to your treatment by the insurance company.
Cashless claims have numerous benefits. They are most helpful when in times of emergencies the person involved can't afford treatment or arrange funds instantly so you can get admitted without caring much about where the money will come from. The paperwork involved is also very little, which makes the process hassle-free.