Cashless Claims Made Easy: Steps To Take Before Admission

Cashless claims have been restored for Bajaj Allianz policyholders at hospitals under the Association of Healthcare Providers of India (AHPI). The suspension was rolled back after both sides settled, though the larger friction over treatment costs, delayed payments, and package rates continues to linger in the background.

Last year, the Insurance Regulatory Development Board of India (Irdai) had told insurers to settle cashless claims in three hours. Also, with cashless everywhere, Irdai wants to ensure that policyholders receive cashless treatment even at hospitals that are not among the insurer's network.

However, a survey by the community social media platform LocalCircles revealed that 43 per cent faced difficulties in health insurance claims. When it comes to cashless claims, the number would be even higher.

Cashless claims are an important feature of health insurance claims as they reduce financial stress during hospitalisations. Patients do not need to pay bills up front. Instead, the insurer directly settles the bill with the hospital. This means that one does not need to arrange large sums of money during an emergency. Patients only need to provide the required documents.

Also, it does not keep money locked up, as it can often take days to get a reimbursement on expenses.

Pre-authorisation Is Important 

To ensure that cashless claims are processed smoothly before admitting a patient, pre-authorisation must be arranged by informing the patient's insurer or Third-Party Administrator (TPA). "It involves calling the insurance company's helpline number or the hospital insurance desk for at least 48-72 hours. The hospital sends a pre-authorisation request along with the medical particulars of the patient," Manish Goyal, Chairman and Managing Director, Finkeda.

Let us say your entire hospital bill is Rs two lakh. Initially, the insurer may allow a pre-authorisation for a smaller amount at first, but they would increase it later.

Basic documents needed: health insurance card or policy number, proof of ID, doctor's admission advice, diagnostic reports, and treatment plan. Insurers or TPAs check them against policy rules before approval. Checking and getting them correct makes it faster. The choice of a network hospital approved by the insurer is no less important.

Verification of the insurer's latest hospital list, either online or through mobile applications, prevents last-minute problems. "A choice of a popular network hospital with special insurance desks provides an option for ease of getting a cashless approval and reduced out-of-pocket costs before admission," says Goyal.