Cashless vs. Reimbursement in Health Insurance

What is a Cashless Claim in Health Insurance?

Cashless claims are insurance claims in which you receive treatment at any hospital that is part of the network, as outlined by the insurer, without paying out of your pockets at the time of hospitalization.

Medical bills are collected directly from the medical facility and then settled by the insurance company.

Then, go to one of your insurance’s network hospitals and present your health card and ID documents. Be aware that you must have your claim accepted by your health insurance provider within a specific time frame.

Things to be aware of about the cashless option:

• The cashless service is available only when you visit one of the hospitals that are part of the insurance company’s network.
• The hospital informs the insurance company of the specific medical condition and the treatment given to the patient.
• While it’s cashless, it’s safe to keep the original charges for medical and hospital expense records.
• Be sure to read carefully the terms provided by the health insurer before availing of the cashless service.
• If the amount you are receiving for treatment is greater than the amount you are assured, the balance must pay by the patient.
• The health insurance provider won’t be held accountable for the total amount of the medical bill in this situation.

What is a Reimbursement Claim in Health Insurance?

The other kind of health claims is those that are reimbursements. For this kind of case, you may visit any hospital, not only those on your health insurance company’s cashless network list.

In this case, you receive the treatment you need at the hospital, and the costs are paid from your pocket.

Once you’ve received your hospital bills, you can request a reimbursement for your health insurance expenses.

To file an insurance claim for reimbursement, you’ll have to provide your medical bills, prescriptions, and medical records.

What are the rules for reimbursement?

If you opt to claim reimbursement, some documents must be sent to the insurer. The claim must be made on time to get reimbursement.

A list of documents to be submitted to claim reimbursement;

• Completed claim form
• Pre-admission investigations and treatment documents
• The discharge summary and the final bill from the hospital
• Cash receipts from hospitals and chemists, etc.
• Cash receipts, reports, and cash receipts for tests that were conducted
• Receipts from surgeons, doctors, or anesthetists.
• A certificate from the consultant doctor concerning the diagnosis
• A copy of the PAN card, the canceled check, or NEFT information

When released, you must provide all of the documents mentioned above to the insurance provider within the specified time. After approval of the claim, the total amount of the insured claim is to be added to your account.

The reasons why your health insurance claim could be rejected

If a claim is filed for permanent exclusions that are mentioned in a health insurance policy.

If medical conditions were not reported when purchasing the policy. Then the claims were filed for this to be used for that.

If you do not provide the required documents for the claim, you will be denied the

In addition, numerous reasons that your health insurance claim is rejected.

You may check this post 9 reasons why Health Insurance claim rejected?

Conclusion:

It is right to say that the cashless claim procedure is more effective than the reimbursement claim process since it’s much more efficient.

Additionally, it is recommended to look for hospitals in the network on the list of insurers.

There is no need to pay the hospital costs out of your pocket.