How Cashless Treatment on Insurance Works: A Step-by-Step Guide

In India, the option of cashless hospitalisation has become an invaluable feature in health insurance policies. It offers policyholders a hassle-free experience during medical emergencies. In simple words, cashless treatment enables policyholders to receive medical care without having to make upfront payments at the time of hospitalisation. Instead, the insurance provider directly settles the bill with the hospital, making the entire process simpler and more convenient for insured individuals.

This guide will take you through the essentials of cashless medical treatment and how it works, step by step.

What is Cashless Health Insurance?

Cashless treatment insurance allows insured individuals to receive treatment at network hospitals without paying bills upfront. Once a claim is approved, the insurance company directly settles the hospital expenses within the coverage limit. This feature is particularly valuable in emergencies when arranging large sums of money on short notice can be challenging. It has the following benefits:

• Financial Relief: It saves you from arranging funds during a medical emergency. This alleviates stress and allows you to focus on your health or the well-being of your loved ones.
• Quick and Efficient Process: Cashless claims are typically processed quickly, with minimal paperwork compared to reimbursement claims.
• Enhanced Access to Quality Healthcare: Many health insurers in India partner with reputed hospitals, ensuring that policyholders have access to quality treatment.
• No Out-of-Pocket Expenses: With cashless medical treatment, you won’t need to cover expenses out of pocket unless the treatment cost exceeds your coverage limit or includes items not covered by the policy.

Step-by-Step Guide

Step 1: Check Network Hospitals

Ensure that the hospital you choose is part of your insurer’s network. Every health insurance provider in India has a network of hospitals nationwide where policyholders can avail of cashless hospitalisation. You can usually check the list of network hospitals on your insurance provider’s website or contact their customer support.

Step 2: Notify the Insurance Provider

Once you’ve chosen a network hospital, the next step is to notify your insurer. The procedure varies slightly for planned and emergency hospitalisations. You must go through your policy documents for the relevant details. Remember to adhere to all timelines and documentary requirements specified by your insurer. 

Step 3: Present Your Health Insurance Card and Submit a Pre-Authorisation Form

At the hospital, you’ll need to present your health insurance card or policy details at the insurance desk, along with valid ID proof. The hospital will provide a pre-authorisation form that you must complete. This form contains information about the patient, insurance policy details, and the reason for hospitalisation.

Step 4: Wait for Insurer’s Approval

Once the pre-authorisation form is submitted, the insurance company will evaluate the claim to determine if the proposed treatment is covered under your cashless insurance policy. They may ask for additional documents or clarifications from the hospital before approving the cashless claim. Niva Bupa processes its cashless claims within 30 minutes.

Step 5: Undergo Treatment and Hospitalisation

Once your cashless claim is approved, you can proceed with the treatment without worrying about payment. The hospital will maintain records of expenses covered under your insurance policy, including room rent, doctor’s fees, diagnostics, and medications, provided they fall within policy limits.

Step 6: Discharge and Final Bill Settlement

After treatment is complete and you’re ready to be discharged, the hospital prepares a final bill and sends it to the insurer. The insurer verifies the bill, checking that all services fall within the coverage, and settles the bill directly with the hospital.

If there are any expenses not covered by your insurance policy (like consumables or additional room rent beyond your policy limit), you will be required to settle these out of pocket before discharge.

Step 7: Receive Discharge Summary and Collect Original Documents

Upon discharge, the hospital will provide you with a discharge summary and copies of your medical records. Collect these and any other relevant documents, as they will be essential if you need to file a reimbursement claim for other uncovered treatments or follow-up care.

Important Points to Keep in Mind

While implementing the above steps, you should pay close attention to the following points:

• Verify Coverage Inclusions and Exclusions: Review your cashless treatment insurance to understand what is covered. Some policies may have sub-limits or exclusions on certain procedures or treatments, and knowing these ahead of time can help prevent unexpected costs.
• Keep a Record of Communication with the Insurer: When you notify the insurer and submit forms, keep a record of all communications, as it can be useful in case of disputes or delays.
• Be Aware of Claim Rejection Possibilities: Cashless claims may be rejected if the treatment is not covered under your policy or if the insurer finds the claim invalid. In such cases, you can opt for a reimbursement claim if you have covered the expenses yourself.
• Use the Network Hospitals for Cashless Benefits Only: Cashless benefits apply only to the insurer’s network hospitals. If you receive treatment at a non-network hospital, you’ll need to pay the bills and file for reimbursement afterwards.

To Sum Up

A cashless insurance policy provides significant relief during medical emergencies, allowing policyholders to access treatment without worrying about immediate expenses. Understanding how the cashless process works can help you maximise this feature and focus on recovery. A smooth claims process and reliable health insurance ensure you’re financially protected against unforeseen medical costs. For a seamless cashless experience, explore Niva Bupa’s health insurance plans, known for 10,000+ network hospitals and prompt claim settlements.