In a cashless claim, the policyholder can seek treatment from any of the network hospitals of the insurance company. On admission, the policyholder must produce the cashless health card provided by the insurer and the expenses incurred for the treatment will be directly settled by the insurance company; you need not pay a single Rupee. For cashless claim, you only need to show your health insurance card at the time of admission in the hospital. Most insurance companies approve cashless treatment within 4 hours from the time of admission at the network hospital.
There are two ways to claim for cashless treatment:
Cashless procedure for Planned Admission:
Choose a hospital from the network as mentioned in the insurance document.
Inform third-party administrator (TPA) 3 days prior to admission & provide a membership number.
Fill cashless request form at the hospital.
Submit the form and medical records to TPA.
TPA will inspect all the documents.
Once approved, the insurance company will settle the hospital bills, which excludes phone charges, attendant charges, food etc.
In case of disapproval, one can file for reimbursement
Cashless procedure for Emergency Admission:
In case of emergency admission, inform third party administrator (TPA) & provide a membership number.
Fill the cashless format the hospital, certified by a doctor.
Send the form along with medical records to TPA.
If a cashless facility is sanctioned, hospital bills will be settled directly.
Seek reimbursement in case of disapproval