What is a Cashless Insurance Claim? A cashless insurance claim allows policyholders to receive medical treatment at network hospitals without paying upfront. The insurance company directly settles the bill with the hospital, subject to policy terms.
How Does a Cashless Claim Work? When admitted to a network hospital, the insured needs to provide their health insurance card or policy details. The hospital contacts the insurance provider for pre-authorization, and after approval, the treatment is covered without the insured needing to pay upfront.
What Documents Are Required for a Cashless Claim? Typically, you will need to provide an insurance policy card, a valid photo ID, and the pre-authorization form filled out by the hospital.
What is a Network Hospital? A network hospital is one that has a tie-up with the insurance provider. Cashless claims are available only at these hospitals, as they have an agreement to process claims directly with the insurer.
Can I Get a Cashless Claim for Emergency Hospitalization? Yes, cashless claims are available for emergency hospitalizations. In such cases, the hospital will request pre-authorization on your behalf after admission, and you should inform your insurer within 24 hours.
Is Pre-authorization Mandatory for All Cashless Claims? Yes, pre-authorization is mandatory for cashless claims. It’s the process where the insurer reviews the treatment details and approves the payment directly to the hospital.
What Happens if Pre-authorization is Denied? If pre-authorization is denied, you may need to pay the hospital bill upfront and file a reimbursement claim later with your insurance provider, along with all necessary documentation.
What are the Common Reasons for Cashless Claim Rejection? Some common reasons include hospitalization for exclusions listed in the policy, incomplete documentation, or the treatment not being medically necessary according to the insurer’s assessment.
Can I Use a Cashless Claim at Any Hospital? No, cashless claims are available only at hospitals that are part of your insurer’s network. For non-network hospitals, you’ll need to pay the bill first and claim reimbursement later.
How Can I Find a Network Hospital? You can find a list of network hospitals through your insurance provider’s website or by contacting their customer service. Most insurers also offer mobile apps that allow you to search for nearby network hospitals.