Home Insurance Health Insurance Cashless Hospitalisation – Not Always Cashless – Why?

Cashless Hospitalisation – Not Always Cashless – Why?

Reimbursement is better than Cashless

Cashless hospitalisation, where you needn’t pay cash at the hospital during the time of surgery or hospitalization is an insurance option preferred by many, as they needn’t make up money during unexpected emergencies. All you need is a card and the insurance providers will pay for you at the hospital.
But is cashless hospitalisation, always credible? Many have experienced situations where cashless settlement policies have not come to their help during the time of need.

How a Cashless hospitalisation works?

If your policy covers surgery and hospitalisation, then walk into a network hospital present your card or card number and get treated without paying a single rupee. If it is not an emergency and is an already fixed appointment at the hospital then inform the Third Party Administrators (TPA) and get it pre-authorised.
A TPA is an intermediate body that liaises between the hospital and the insurance agent verifying policies and giving clearance for cashless hospitalisation to be processed on behalf of the insurer. In emergencies, TPA takes no more than six hours for cash settlement and in other cases no more than four days for the same. The insured needs to always check which hospitals, treatments, illnesses and surgeries are covered under the policy.

Recommended Read : Reimbursement better than Cashless

How Cashless hospitalisation becomes unreliable?

There have been circumstances where the TPA was informed in advance about the hospitalisation and surgery but when it took more days than expected for the discharge from hospital, the TPA did not redeem the entire amount spend at the hospital rather only the day of surgery was covered. Later the complete amount had to be paid to the hospital and then later claimed from TPA after chasing for two months which amounted to just 80%.
There have also been instances where the hospital asked the insured to pay the bills at the hospital upfront and then later reimburse the same form the TPA later regardless of submitting the cashless card at the hospital. The same later led to the intervention of the insurance broker with the TPA for processing the cashless policy. Hence this would be of no use, if we the insured have to pay the bill or later get it reimbursed.

Limitations of Cashless hospitalisation

The restraint that Cashless Hospitalization faces is that the insured can only be taken to a network hospital listed under the insurance providers. Even under emergencies, if you want to take the insured to a nearby hospital to save time, with cashless hospitalization this is not a possibility. While other insurance policies, allow the insured to go to any hospital and then later claim the money. Ignorance of the insured on how the policy works creates tension for the insured and rejection by the TPA. TPA can sometime give the insured and the insurer a hard time rejecting the policy, making them run around for reimbursement and delaying the cash settlement. Hospitals also have no uniformity in the charges creating havoc.

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  1. This is a system failure. The health policies, the laws allows such laxity to be openly practised due to lackadaisical attitude on the disciplinary action front. And as usual, the customer is the end sufferer. The best reason given is, “Please read all the documents carefully”. Transparency is the main factor which is far from reality. Unless health claim laws are upgraded and enforced with rigour, unfortunately this will continue to happen. In the end, business overweighs human life, money overweighs humanity

  2. I agree with the above commenter. It is such a shame that if we have an emergency, our cashless hospitalisation policy won’t cover all hospitals. When we are in need, we are in need. And when we have no cash for that emergency need, it does not mean we can automatically just “get well” on our own. You have to be so careful with insurance policies these days, there are so many catches applied to what we invest in – especially our health, which ensures we can go on making an income.

  3. One of the greatest myth and misunderstanding among the people is about cashless hospitalization. This article demystifies it and removes the veil from over the term of cashless hospitalization. The article speaks magnificently about the truths behind cashless hospitalization. I got a lot of knowledge and would love to read more articles from this writer.

  4. Cashless hospitalization is just an advertisement gimmick fooling the innocent man. With so many terms and conditions that we at times overlook them. I feel reimbursement works better than cashless because at the end we will get the amount. But in cashless the scene is not so.

  5. Cashless hospitalization is a good option for the insured , provided they check with the TPA whether the hospital is covered under the insurance. Ignorance of this can lead to delays in settlement and cause a lot of unnecessary tension. Another grouse point is that in cases of accidents , the nearest hospital is the best option, but that hospital may not be covered.

  6. There are some countries in the world where health care, including hospitalizations, surgeries, and everything else connected to medical treatment are regulated by a state. Health care is for ˝free˝,as you are paying, all your adult life a part of your salary or other incomes as fixed contribution for medical health care. That money goes to the state register in order to finance health care. Slovenia is one of those countries. Which possibility is better – who knows?


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