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.
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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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