The word “cashless” itself conveys the meaning: it means not requiring cash. When you combine the terms “cashless hospitalization” and “cashless treatment,” it means neither admission into a hospital nor payment of a treatment’s costs must be made with cash by the policyholder.
How is that even doable? Well, most people are familiar with the reimbursement policy where you submit the bills, the insurance company submits the claim, and you receive full or partial reimbursement depending on the policy. However, with cashless treatment, no payment is necessary. Here, insurance companies have a list of network hospitals where they have agreements with particular hospitals based on their services and treatment costs.
If you receive treatment at one of those hospitals, the insurance company and network hospital will negotiate a price. By using the cashless facility, the policyholder is exempt from payment.
What advantages does cashless hospitalization have?
With cashless treatment, the policyholder need not be concerned about rushing to a bank or ATM or asking a friend or relative for cash in case of an emergency. The goal of cashless treatment is to prevent such situations and lessen the stress associated with making financial arrangements in advance. However, the settlement amount is capped at the maximum amount insured by the policyholder.
The best medical care is provided when you are properly covered because insurance companies evaluate the hospital’s services before signing a contract.
Depending on the severity of the illness, there are typically two situations: either a person needs emergency treatment or plans for future treatment; as a result, cashless treatment is also offered in these two ways:
Planned hospitalization: Under this scenario, the policyholder typically has enough time to choose the best network hospital for their condition. Important things to remember are to let your service provider know about the condition and obtain TPA approval. (TPA, or third-party administrator, is a company that handles payment of bills on behalf of the insurance provider and works with hospitals to arrange payments.)
Then, carry out the subsequent actions:
– Complete the paperwork necessary for hospitalization, such as preauthorization forms. The form is available from the insurance desk of the network hospital or the company’s official website.
– Once completed, turn in the form to the insurance desk. Each hospital in the network has a dedicated Insurance desk that can assist the policyholder.
– Now the application will either be accepted or rejected based on several variables, including the illness’s nature and the policy’s terms and conditions.
– Once it has been accepted, the treatment can start after the third party administrator (TPA) has sent an approval letter.
Emergency hospitalization: Policyholders must follow procedures similar to planned hospitalization, including filling out preauthorization forms, submitting them, and receiving TPA approval. In an emergency, the Third Party Administrator (TPA) must decide whether to reject or approve the request within six hours for the treatment to continue.
– If TPA rejects the request or you are unable to wait for TPA approval, you may pay the bill now and request reimbursement later.
The policy terms and conditions, including inclusions and exclusions, waiting periods, pre-existing condition exclusions, and many others, should be carefully read by the policyholder before purchasing an insurance policy.