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Know the Challenges to Cashless Health Insurance Plan
Jan 4, 2023

All You Should Know- Challenges of Cashless Health Insurance

The COVID-19 pandemic has certainly been an eye-opener for one and all. One of the key things that grabbed attention was understanding the importance of having a suitable insurance policy in place. For the last couple of years, medical expenses have been rising. It is almost impossible to ignore or neglect medical bills or expenses. With the ongoing pandemic, it certainly has become more visible than ever. For any unforeseen event, having a health insurance policy will keep you financially prepared for any medical emergency. Medical insurance coverage enables to overcome the expenses that otherwise need to be paid out of pocket.

Understanding the Cashless Benefit Option in Mediclaim Policy

One of the significant benefits of a health insurance policy is the cashless option. As the name suggests, with cashless benefit, the policyholder is eligible to avail of the cashless treatment at the network hospitals. In case of adversity, if the policyholder gets hospitalized at any of the network hospitals, the medical bills will be settled without paying anything.

What are the Challenges Related to Cashless Treatment?

When availing of the cashless claim benefits of the health insurance plan, the policyholder might face certain challenges. These challenges can be avoided if things are taken into consideration. Let us have a glance at some of the common challenges usually faced by a policyholder in the case of cashless treatments:
  1. Lack of Knowledge: There are times when a health insurance claim gets rejected by the insurance companies because of a lack of knowledge of the policyholder. While making a claim ensure to go through the policy terms and conditions carefully. It helps to avoid any inconvenience during the claim settlement process.
  2. Lack of Documents: Sometimes the insurer can reject the cashless claim request because of a lack of proper documents. Hence, it is prudent to keep all the claim-related documents handy for a smooth process of claim. In case of any confusion, get in touch with the TPA or read the policy document that lists the necessary documents.
  3. Understand the Exclusions: When any claim is made for a health condition that is excluded under the health insurance policy, mostly it will be rejected by the insurer. The exclusions offered under a health insurance plan differ from insurer to insurer. It becomes of utmost importance to understand both inclusions and exclusions offered under the plan. It helps to avoid further confusion during the cashless claim settlement process. Do not claim for a medical condition that is excluded under the purchased policy.
  4. Network Hospitals: The cashless treatment can be availed at the network hospitals provided by the insurance company. In case of a medical emergency, if no network hospital is nearby found, avail the treatment at the non-network hospitals. Such medical expenses incurred will get reimbursed. While you zero down the medical insurance ensure to have a look at the network hospitals and keep a list of it handy.

The Bottom Line

During a cashless claim settlement process, consider the challenges mentioned above and avoid them as much as possible. Read the health insurance documents carefully to avoid any confusion or delay during the claim process. One should strategically make use of the cashless treatment options and adhere to the requirements. Ensure to have the list of network hospitals in your area handy. Go with a plan that fulfills your and your family's needs.   *Standard T&C apply Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.

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