Why You Shouldn't Depend On Cashless Health Insurance For Emergency Hospitalizations?

What Is Cashless Claim?

Before the introduction of cashless facilities, you had to pay for hospitalization costs out of your own money before submitting an insurance claim for those costs. A reimbursement claim is what this procedure is known as. This forced families to always have some cash on hand to pay the hospital bill, receive the necessary medical care, and then submit an insurance claim for reimbursement.

Insurance companies now have a list of hospitals where you can simply receive early approval from the insurance company, which means they will approve your claim and agree to pay the money directly to the hospital. This is due to the introduction of cashless facilities. This was established to lessen the stress on your family to manage papers and arrange a large sum of money. In a cashless system, the hospital and insurer communicate and exchange paperwork before the insurer pays the hospital the approved sum in full.

Particularly if you are experiencing a planned hospitalization, this is rather simple and hassle-free. You give the insurance provider advance notice, along with the doctor's recommendations, specifics of the suggested course of treatment, an estimate of the cost, etc. They examine your medical needs and approve a price. They pledge to make a cash payment to the hospital.

1- Pre-authorization requests are typically submitted as the first step in a cashless claim when hospitalization is planned, namely, when you are aware that you will need to be admitted for treatment, surgery, or another procedure.

2- The hospital health insurance desk will also need copies of your identification documents, health care, and policy paperwork before submitting them to the insurer on your behalf.

3- After reviewing all the information, the insurer will grant a pre-authorization for the maximum amount that can be paid.

4- After this, you'll enter the hospital and undergo the necessary procedures or treatments.

5- The final bill is submitted to the insurer before discharge (again, via the hospital insurance desk itself), who then reviews approves, and pays the hospital directly.

6- The bill will reflect any charges that the insurance does not cover, and you will be responsible for paying them out of pocket.

This May Not Work In Emergency

You'll observe that a pre-authorization cannot be obtained in advance in the event of emergency hospitalization. And that's why it's complicated.

Pre-authorization from insurers may take 6 to 24 hours because they must assess and confirm that you have sufficient coverage, the therapy is covered, etc. You won't have this time if you are in an emergency. Therefore, even when a cashless facility is offered, the hospital will require a deposit before granting you access to its services.

If the admission was the result of an accident, which is a combination of numerous emergency conditions, you will receive emergency care to stabilize you, but someone will need to pay an advance fee to admit you to a room or ward.

The Hospital Desk Isn't Open 24x7

The hospital department that processes the claim on your behalf does not function 24 hours a day, 7 days a week, like an insurance firm, which adds to the difficulty. There may be set business hours and holiday closings. As a result, the cashless claim process won't even be started if you are admitted during a closed hospital desk shift. You will thus need to pay a deposit.

Will The Hospital Return The Advance Payment                         

When the insurance company confirms the cashless claim request, which could take 6–12 hours following the submission of all the documentation and bills, the hospital will reimburse you for the advance payment that you made to the hospital. However, hospitals may retain a small fraction of the deposit for any reductions the insurer may make in the final approval, which comes after your discharge papers and the full amount of the bill have been paid.  

What Can You Do To Ensure The Best Cashless Claim Settlement Experience

The following three steps will help you have the greatest cashless claim settlement experience possible:

1- If your treatment is scheduled, go to the hospital beforehand to start the cashless claim procedure. As a result, you won't have to pay an advance fee and the cashless system will be approved on the day of entrance.

2- Always keep a credit card open and an emergency fund on hand. They will be useful if you have to make an advance payment to be treated or admitted to the hospital.

3- Keep soft copies of your cashless card, policy document, and Aadhar card of your family members in an easy-to-access drive folder on multiple smartphones in your house. This will ensure you have access to all the documents you need for admission ready - even in an emergency.