Business & Finance

Cashless Claim Settlement vs Reimbursement Process in Health Insurance

Process-in-Health-Insurance

Health insurance has truly become a life-saver. With the cost of treating various health-related issues has increased substantially over the years, insurance is a key to obtaining quality healthcare at the time of need. If you have a valid health insurance policy, the liability to bear unforeseen medical expenses shifts to your insurance provider. This eases up a huge financial burden along with a lot of stress for the family.

There are two ways in which you can file a claim

  1. Cashless claims– if you decide to get treatment from any of the network hospitals then you are eligible for cashless claims. In cashless claims, the insurance provider directly settles the hospital bills with the hospital and you don’t have to pay the bills from your funds. There may only be a small portion that has to be self-funded.
  2. Reimbursement claims- If you choose to get treatment from a non-network hospital, then you are eligible to apply for reimbursement claims. Here, you have to pay the hospital bills first and then file for reimbursement. The insurance company will validate all documents and reimburse the expenses to you.

Network Hospital refers to all the hospitals that are named in your insurance policy. While signing the papers it is recommended that you check for these hospitals before you seal the deal. It is always advisable to go for an insurance provider who has a good network so that at the time of need, you’re not limited with fewer options.

Procedure to file for the claim

The procedure to file for the claim is an important one. The amount of the claim and the validity of the claim is determined in this step.

Under cashless claims, if the treatment is planned then the policyholder is required to inform the insurance company at least 4 days before. But if it is an emergency, the hospital is required to fill a cashless claim request form which is then sent to the insurance provider.

In both these situations, the insurance company will inform the hospital about the policy details and the amount of coverage available. If the claim is rejected then a rejection letter is sent stating the reason for rejection.

Under reimbursement claims, the policyholder needs to settle the hospital bills first and then file for a claim submitting all the documents that are required. The provider will then evaluate the claim and decide on the reimbursement amount. If they reject the claim, a letter is sent that states the reason. Some of the documents that are required are-

  1. Duly filled claim form
  2. Medical Certificate
  3. All bills and receipts (original form)
  4. Discharge summary
  5. Prescriptions and Cash memos.

Differences between Cashless and Reimbursement Claims

1. Individual Liability-

Under cashless claims, the individual is not liable to pay for the expenses incurred at the hospital. On the other hand, the individual is liable to pay for the expenses before filing for reimbursement under reimbursement claims.

2. Speed of settling claims-

In cashless claims, the claims are settled immediately whereas it may take some time under reimbursement claims.

You should always be prudent in your choice of claims as your situation might differ from others. Health insurance helps you take care of your family financially in times of emergency and it forms a safety net for you. We hope this article has been helpful in providing all information pertaining to medical insurance.

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Mursaleen

Hi. I'm Mursaleen Siddique, The guy behind UltraUpdates.com. I'd rather call myself a struggling Blogger. I love Blogging with WordPress, Covering Tech, General Topics, Graphic & Web Design Inspiration., Feel free to get in touch via mentioned social media platform.

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