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Health Insurance Claim Process: A Reimbursement Claim vs. a Cashless Claim

KJ Staff
KJ Staff
Health Insurance
Health Insurance

With the ever-rising health care costs and increasing risk of lifestyle diseases, it has become imperative to keep you and your family’s health financially protected with a reliable health insurance plan. However, with the multiple types of health insurance plans available, choosing the best health insurance policy for yourself and your family might get overwhelming. 

Herein, comparing different health insurance plans based on their benefits, premium amount, terms, and conditions across different providers can prove to be helpful in choosing the right policy. One of the most important things you should look for in the policy specifications is that it should be cashless health insurance, meaning it should have a provision for cashless claim settlement. 

Commonly, there are two types of claim settlement processes – cashless claim settlement and reimbursement claim settlement. 

1. Cashless Health Insurance/Cashless Claim Settlement

You can avail of this benefit if you get your treatment done from one of the insurer’s network hospitals. The cashless claim settlement process varies with the type of treatment, which are of two types – unplanned or planned treatment. Unplanned treatment at a network hospital typically happens during emergencies. 

a) Claims Process for Planned Treatment at a Network Hospital

Under this, the policyholder is required to inform the insurer in advance about the treatment or hospitalization required ahead of time along with all the necessary details and documents, including the filled cashless claim form. Then, once the insurer cross-checks and approves everything, it notifies the insured and the network hospital about the same. Once the treatment is done, the insurer settles the medical bill directly with the hospital. 

b) Claims Process for Emergency Treatment at a Network Hospital

In the case of emergencies, the insured can directly contact one of the customer care executives and know about the nearest network hospitals. You can even look for the list of network hospitals in your policy documents. Thereafter, with the help of your health insurance card and other details, you can easily avail the benefits of your cashless health insurance. Your hospital bill will be paid directly by the insurance provider. However, if your cashless health insurance claim is rejected due to any reason, a letter is sent to you stating the reasons for rejection. 

2. Reimbursement Claim Settlement

Under health insurance, the reimbursement claim is usually made when the policyholder opts to get admitted to a hospital of their choice, i.e., a hospital which is not covered in the insurer’s list of network hospitals. In such a case, you’ll not be eligible to avail of a cashless claim facility. Therefore, in the first place, then you will have to pay all the medical bills and other associated costs involved in the treatment and hospitalization. 

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Thereafter, to avail claim reimbursement, you will have to provide all the required documents, such as original hospitalization bills, identity card, etc., to the insurer. Your insurance provider will then cross-check and evaluate everything at their end to ensure that everything is within the scope of your insurance policy and nothing is fraudulent, after which the amount is disbursed to the insured. In case the disease from which you’re suffering is not covered under your insurance policy, your claim might get rejected; therefore, it is advisable to read through your policy specifications in advance. 

Which One to Choose: Reimbursement or Cashless Health Insurance?

When you consider reimbursement or cashless health insurance plans, you’ll find that choosing cashless health insurance would be the best decision as it spares the policyholder from financial burdens. Even during emergencies, you can immediately go for the treatment without worrying about the funds. 

However, in the reimbursement process, it is vital to have funds for paying the medicals bills at the time of discharge. Though, the amount will be reimbursed later by the insurance provider. 

Therefore, if you stay covered under a cashless health insurance policy, you can stay worry-free right from being diagnosed with the disease to paying off your medical bills. Furthermore, to rest assured of speedy and hassle-free claim settlement, it is vital to choose one of the reputable insurance providers such as tataaig.com. They are known for their unparalleled services, uninterrupted support, and have a network of 7200+ hospitals, making them one of the preferred hospitals for availing of cashless health insurance. 

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