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Previously, individuals with health insurance could only access cashless treatment at hospitals affiliated with their insurer's network. However, the introduction of the 'Cashless Everywhere' system now allows policyholders to receive cashless treatment at any hospital, regardless of its network status.
1. Receiving cashless treatment at any location requires prior notification to the insurer and a set of documents as compared to a network hospital.
The insurance company discusses rates with out-of-network hospitals individually, and if an agreement cannot be reached, one has to pay for the treatment upfront and then submit reimbursement claims to the insurer.
If one gets treated at a hospital that is specially excluded, then they will not receive cashless treatment or reimbursement in which case the entire payment has to be made out of own pocket.
If a claim is denied due to treatment at an excluded hospital, policyholders should review the insurer's reasons for rejection. If they disagree, they can appeal by submitting additional documents.