Relationship manager
For every customer
Cashless Mediclaim: Challenges
Experts always advise buying a health insurance plan which promises the benefit of cashless claims so that the financial burden to pay off the hospitalization bills does not fall on your shoulders. An average middle-class man finds it difficult to meet the huge hospitalization expenses associated with medical contingencies. This is the sole reason why a health plan is bought and the required premium is paid.
Policybazaar exclusive benefits
30 minutes claim support##
(In 120+ cities)
24*7 claims assistance
In 30 mins. guaranteed*
Instant policy issuance
No medical tests~
People trust Policybazaar^
7.7 crore
Registered consumers
50
Insurance partners
4.2 crore
Policies sold
Policybazaar is one of India's leading digital insurance platform
Find affordable plans with up to 25% Discount**
Select members you want to insure
More Members
Maximum child sum can be 4
-
Home
-
Health Insurance
-
Articles - GHI
- Cashless Mediclaim: Challenges
Though most plans offer cashless mediclaim and reimbursement claim settlement policy, reimbursement option is not favored because it involves the policyholders to pay the bills initially and then get it settled from the insurer. It is argued that a common man faces difficulty in meeting such expenses and so a cashless claim is better. However, a cashless mediclaim plan also has some challenges that make availing the claim a nightmare.
A cashless mediclaim insurance plan has two concepts; one is the Preferred Provider Network (PPN), which is a hospital that is tied-up with the insurer to provide cashless treatments to the policyholder. The other concept is that of a Third Party Administrator (TPA) that is the mediator between the mediclaim insurance company and the policyholder and is responsible for the smooth settlement of claims.
If a policyholder is admitted in a PPN hospital and identifies him with the TPA, he could avail of a cashless treatment and his hospital bills would be settled by the mediclaim insurance company directly without him having to shoulder the burden himself. This is the complete concept of a cashless hospitalization. However, this form of a claim settlement process is fraught with challenges and protocols.
Challenges Involved in Cashless Mediclaim Insurance
1. Getting a Part of the Claim Settled
A very common scenario is where the mediclaim insurer settles only a part of the total expenses incurred. For instance, you might be hospitalized for appendicitis for which the insurer is paying about Rs.25, 000. However, you develop a complication post-surgery which results in an extended hospital stay chalking up a total bill of Rs.40, 000, out of which the mediclaim insurer pays only Rs.25, 000 as cashless claim and the pending amount is later reimbursed.
3. Not Getting the Facility of Cashless Treatment
This happens mostly in emergency cases where the TPAs require time to facilitate cashless mediclaim treatment. In such cases, the insured or his family is asked to bear the costs and later get them reimbursed from the insurer despite the insured being admitted in a network hospital
3. Excluded Treatments
It is an obvious one because treatments which are excluded from the scope of your health plan would not be provided by your mediclaim insurer.
4. The Document Jumble
Availing cashless treatment requires adherence to documentation, especially the pre-authorization form which is to be submitted to the TPA to facilitate cashless treatment. Policyholders, being ignorant, fail to stick to the documentation, which results in difficulties in getting a cashless claim.
You May Like to Read: How Does Cashless Mediclaim Work?
How to Tackle Challenges Associated With Cashless Mediclaim Policy?
There are some steps to be followed and rules to be remembered if you do not want to get embroiled in a difficult claim settlement process.
These are
- Check out the list of the PPN hospitals and always get admitted in a network hospital to ensure cashless mediclaim settlement.
- A pre-authorization form is a mandatory requirement when it comes to availing a cashless claim. This mediclaim document needs to be filled and submitted with the TPA in a specified time frame. If the hospitalization is emergent, the form should be submitted within 24 hours of being hospitalized. In case of planned hospitalization, the form should be submitted at least 4-5 days in advance. Furthermore, the complete set of hospital bills should be submitted with the TPAs for a smooth mediclaim settlement process.
- Always have the health card handy to be produced to the TPA for identification purposes.
- Check the list of treatments that are excluded from your coverage before raising a claim.
A cashless settlement, though convenient, has certain challenges when it comes to fulfilling the promise made. The challenges may stem from the fault of the policyholders, TPAs or hospitals. Passing the blame would be useless as the policyholder would be the one who ultimately suffers. You, as a policyholder, should take the precautionary measures to ensure adherence to protocols which would help you in getting a cashless settlement with ease and convenience.
Search
Health insurance companies
Disclaimer: The list mentioned is according to the alphabetical order of the insurance companies. Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by any insurer. For complete list of insurers in India refer to the Insurance Regulatory and Development Authority of India website www.irdai.gov.in
Health insurance Articles
- Recent Article
- Popular Articles
17 Dec 2024
How to File a Claim for Maternity Health...
Maternity insurance is one of the best investments married couples
Read more
03 Dec 2024
Health Insurance Checklist
Health insurance is a crucial investment you can make to secure
Read more
26 Sep 2024
Can You Get Maternity Insurance If Already...
Pregnancy is one of the most beautiful phases of a woman’s life
Read more
12 Aug 2024
Moratorium Period in Health Insurance
Getting a health insurance claim accepted for pre-existing
Read more
30 Jul 2024
Is Dengue Covered by SBI Health Insurance?
Dengue, a common vector-borne disease, causes high fever, severe
Read more
*We will respond in the first instance within 30 minutes of the customers contacting us. 30-minute claim support service is for the purpose of giving reasonable assistance to the policyholder in pursuance of the claim. Settlement of claim (including cashless claim) is the responsibility of the insurer as per policy terms and conditions. The 30- minute claim support is subject to our operations not being impacted by a system failure or force majeure event or for reasons beyond our control. For further details, 24x7 Claims Support Helpline can be reached out at 1800-258-5881.
*Product information is authentic and solely based on the information received from the Insurer. Policybazaar is acting only as a facilitator and claims settlement shall be at the sole discretion of the Insurer. Policybazaar does not provide any medical or surgical advice or diagnosis and is not responsible for your interactions / treatment by a medical practitioner/hospital. Please consult a registered medical practitioner for any medical or surgical advice. The Information that you obtain or receive from Policybazaar, and its employees, or otherwise on the Website is for informational purposes only. As per the Insurance guidelines, you are allowed to cancel the policy with-in 30 days from the date of Issuance of policy.This option is available incase of policies with a term of one year or more.
*All the health insurance plans cover hospitalization expenses including COVID-19 treatment cover up to the specified limits. You can also buy specific COVID-19 health insurance policies such as Corona Kavach Policy and Corona Rakshak policy.
**All savings and online discounts are provided by insurers as per IRDAI approved insurance plans. #Tax Benefits are subject to changes in tax laws. GST Exemptions depend on fulfilment of qualification criteria and submission of relevant documents.
*₹1748/month is the starting price for a 1 crore health insurance for an 18-year-old male, with no pre-existing diseases. Discount on renewal premium is subject to the number of wellness points earned in the health insurance policy. For more details about the plans, please read the sale brochure carefully to get upto 100% discount on renewal premium.
*₹400/month is the starting price for ₹ 5 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases
*₹541/month is the starting price for ₹ 10 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases
*₹762/month is the starting price for ₹ 1 Crore Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases
*₹243/month(₹ 8/day) is the starting price for a 5 lakh health insurance for a 20-year-old male, non-smoker, living in Bengaluru with no pre-existing diseases
*₹2020/month is the starting price for ₹ 1 Cr Health insurance for a 50 year old male & 50 years old female, living in Bangalore with no pre-existing diseases rounded off to nearest 10.
*₹390/month (₹13 per day) is starting price for 1 cr. Health insurance for 25 years old male, with pre-existing diseases, residing from tier 1 city rounded off to the nearest 10.
*No medical tests are required unless requested by the insurer’s underwriter. In-case of pre-existing diseases relevant medical proof would be required as per the terms and condition of the policy opted.
*The values taken for effective cost calculation are indicative values and may change as per the selected plan.
*Coverage upto double the amount of Sum Insured is available on certain covers for a minimum plan of Rs. 5 Lakh on the first claim only to an individual of upto 45 years of age with no pre-existing diseases. The benefit is available with or without extra cost depending on the plan chosen.
*Coverage of pre-existing diseases is provided by insurer as per their underwriting policy.
*The scope of coverage may vary from plan to plan.
~Source: Google Review Rating available on:- http://bit.ly/3J20bXZ
##On ground claim assistance is available in 114 cities
Tax Benefits are subject to changes in tax laws. GST Exemption depends on fulfilment of qualification criteria and submission of relevant documents as required by the insurers. For more details on risk factors, terms and conditions, please read the sales brochure and applicable rules and regulation carefully before concluding a sale.
STANDARD TERMS AND CONDITIONS APPLY. For more details on risk factors, terms and conditions, please read the sales brochure carefully before concluding a sale.
Policybazaar is a registered Composite Broker |Registration No. 742, Valid till 09/06/2024, License category- Composite Broker| Visitors are hereby informed that their information submitted on the website may be shared with insurers.
Policybazaar Insurance Brokers Private Limited | CIN: U74999HR2014PTC053454 | Registered Office - Plot No.119, Sector - 44, Gurgaon, Haryana - 122001 Contact Us | Legal and Admin Policies
© Copyright 2008-2024 policybazaar.com. All Rights Reserved.
Insurance
Calculators
Payment Methods
Secured With
Follow us on
