Challenges of Cashless Health Insurance

Getting yourself health insurance is of prime importance when you begin earning your living. So, if you don’t have health insurance, immediately plan for one and have a peaceful sleep every night from then on. Once you have decided on availing of the best health insurance, the first thing you can opt for is a cashless insurance cover that offers a wide network of hospitals, cashless claims and fast reimbursements.

This Short Story Explains What “Cashless Health Insurance” Is About

Your friend is diagnosed with a life-threatening ailment and has to be hospitalised for an operation. He calls you to accompany him to the hospital and tells you a cashless insurance policy covers him. Seeing his relaxed mood, you both reach the hospital in a positive and calmer frame of mind. Your friend hands over his health insurance card at the hospital reception and proceeds towards the operation theatre. Most large hospitals have insurance representatives within their premises, and someone from the insurance company is there to handle your friend’s documents and payment formalities directly with the hospital.

After the operation, your friend can recuperate better, assured all payment formalities have been taken care of. Other than a very small amount (maybe 3-4%) of the total hospital bill, comprising of items generally not covered by the insurance company, are cleared when checking out from the hospital. Your friend has paid barely 3% of the total hospital bill, which is around 2 Lacs. This is so convenient indeed! Your friend will most certainly be paying his health insurance premium again.

How Does the Cashless Benefit Work for You?

Most Health Insurance companies have a network of hospitals across the city and country. All you do is choose the type of hospital that best suits your treatment needs. The “cashless” benefit works in the same way as explained in the story above. The insurance company settles all the bills related to your treatment with the hospital directly. While selecting the insurance company, you can check out the list of hospitals on their website.

Niva Bupa Health Insurance has a vast network of 7600+ hospitals across the country, and its comprehensive and affordable healthcare policies serve as your most trusted health insurance companion. 

What is to be Done for a Smooth Cashless Experience?

• Approach the insurance desk at the chosen hospital and request a pre-authorisation form.
• Print out the form from the TPA (Third Party Administrator) website.
• Fill out the form and submit it at reception. The TPA helps you with the insurance formalities.
• Its fast reimbursements, cashless claims and no cumbersome paperwork at Niva Bupa. You get your choice of treatment, cashless!

What are the 2 Big Benefits of Cashless Claims?

• No need to arrange for a huge amount of money at short notice. Your health insurance takes care of that. 
• In the event of an emergency, you can get admitted to a network hospital without having to worry about finances. 

What are the Challenges for Cashless Claims?

• Plenty of treatment procedures like specific medical tests, documentation charges, routine check-up expenses, service or registration charges of the hospital etc., are not covered under cashless claims. Before signing up for a cashless policy, you need to know what is covered and what is not.
• Some insurers pay a portion of the treatment cost and pay for the balance later. In that case, the patient needs to pay cash for the unpaid part and claim the balance later from the insurer. 
• Cashless treatment is hassle-free if the treatment is availed from among the networking hospital listed by the insurer. The policyholder needs to be admitted to the network hospitals to get the true benefits of cashless hospitalisation.
• Perfect documentation is also a part of cashless claims, and producing all the documents at the time of an emergency could be quite challenging. Insufficient documentation could lead to problems during the claim stage; hence it is advised to note the documents required by an insurer before buying a cashless policy. 
• Cashless treatment could be a major challenge during an emergency as the approval could take time. Hence the hospital could ask the patient to clear the payment to avoid delayed treatment. The claim then is reimbursed later, defeating the purpose of cashless insurance. 
• The validity of cashless health insurance is generally one year.

What is Not Included in Cashless Claims?

• Any pre-existing illnesses like HIV / AIDS.
• Any injuries caused by acts of terrorism.
• Non-medical expenses like cosmetic surgery.
• Pregnancy and Abortion are not covered.
• Any blood test or CT scan is not covered.
• Miscellaneous charges like admission fees etc., are not covered. 
• No coverage for health supplements like protein shakes or health tonics.

Considering all the factors discussed above, it's recommended that you check all the terms & conditions, inclusions and exclusions when you sign up for your health insurance. You can choose the Niva Bupa cashless health insurance for hassle-free quality treatment and a happy experience.