OVERVIEW
What would you say if I told you that a guy named Ramesh bought a scooter but instead of riding it, he always used to drag it manually? Sounds a little strange right?
In this blog, we will discuss how most of the people can make their lives a lot easier when it comes to health insurance claims.
Medical science has increased the longevity of our lives but that has come with a cost and post COVID, the over costs of medical treatment have gone up. With such an increase in health issues and costs of treatment, another thing which has gone up is the ICR of the insurance companies i.e. Incurred Claims Ratio. ICR is basically the total amount of claims paid against the total amount of premiums collected by an insurer.
In order to control this IC, insurance companies tie up with hospitals at discounted rates and promote cashless treatments across all major cities.
TYPES OF HEALTH INSURANCE CLAIMS FILING
- CASHLESS MODE: Cashless mode is like Ramesh riding the scooter. See, most of the insurance companies have a tie up with a lot of hospitals and they have pre-decided on the rates for various treatments. In this mode, the insured has to ensure that he/she is admitted in a PPN hospital i.e. preferred provider network hospital and provide them with your policy details. It is then the task of their TPA desk to get both preauthorization and final claim approval from your insurance company.
- REIMBURSEMENT MODE: For all claims in which an insured does not take the cashless treatments, he/she must file a reimbursement claim along with all the medical documents and a claim form. In this, the insured pays upfront to the hospital and must wait for a few days to get his claim amount back.
THE PROCESS OF TAKING CASHLESS CLAIM FACILITY
- The first step is to find out the hospitals which are on the CASHLESS panel.
- Intimation to the insurance company and admission
- Applying for the preauthorization from the insurer which is generally done by the TPA desk.
- Getting the treatment done and applying for final approval before discharge.
- Usually, no additional payment is required other than consumables deducted by the insurer.
- In case your cashless claim is rejected, you must apply the same as a reimbursement claim
THE BENEFITS OF THE CASHLESS MODE
- Easy on Pocket: No payment is to be made by the insured as the hospital will receive the claim amount directly from the insurer.
- Saves time: As the claim is cashless, save the insured’s time to fill forms and apply manually.
- Lower Wait time: Faster claim processing as the hospital is on network and aware of the process.
- Quality Services: Better facilities as the insurer ensures a minimum quality and certification criteria before empaneling the hospital.
- Guard of emergency: In medical emergencies, cashless acts as a life saver as insured might not have liquid amounts for treatment all the time.
CONCLUSION
Cashless health insurance claims are a blessing for policyholders, offering convenience and peace of mind during medical treatments. Reimbursements should only be applied when cashless is not available or rejected. An insured should always maintain a list of network hospitals in the vicinity of his home and work.
The true essence of health insurance is a cashless claim wherein the insured can get treated without any hassle and payments out of pocket.
By Chirag Nihalani – General Manager
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