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Cashless Claim vs. Reimbursement Claim
Take informed decisions with IIFL Insurance:

Which is Better Cashless or Reimbursement Claims?

Table of Content

Overview

Lifestyle is changing today, and most people suffer from health disorders that affect their quality of life. Moreover, they face difficulties in managing the rising medical costs due to financial obstacles. Therefore, those who want protection against critical illnesses should choose a health insurance policy because it gives ways to overcome unwanted problems to a large extent. On the other hand, it is necessary to know more about the plans from various sources before investing money. This will help select the right plan which satisfies the needs of policyholders.

A policyholder should understand how the claim process works in detail. this gives ways to minimize complex issues. For example, cashless claims and reimbursement claims are the types of medical claims offered by most insurers. However, it is imperative to learn about the procedures followed in each claim to receive amounts with ease. Not only that, they allow a policyholder to get maximum protection from medical inflation to experience peace of mind.

What is a Cashless Claim?

A cashless claim allows a policyholder to receive treatment from the network hospital at the time of hospitalization without paying. That means an insurer will pay the expenses directly to a hospital, and there is no need to submit any documents. Most insurance companies offer cashless claims in an array of hospitals enabling policyholders to undergo treatments for health issues without paying to the hospital. It is very simple and convenient that will save time. At the same time, policyholders should inform about the hospitalization in advance when it comes to a cashless claim. 

What is a Reimbursement Claim?

reimbursement claim is entirely different from a cashless claim, and policyholders have to pay the hospitals first and then file for the reimbursement. One should submit various documents such as discharge summary, medical bills, doctor’s prescription, surgical bills, hospital expenses, etc. An insurance company will review the claim properly and settle the amounts after completing the verification process. Reimbursement claims may take more time to be cleared when compared to cashless claims. A policyholder has to request reimbursement when he/she wants to claim amounts for medical expenses undertaken.

Procedure for a Cashless Claim

  1. Planned treatment 

For a planned treatment, a policyholder should intimate his/her insurance company at least 4 days before a medical procedure. Policyholders should submit a cashless claim request to the insurer through email, post, or fax in the next step. They can even contact the customer care team of the insurance company to know more details. Finally, policyholders should show their card and the confirmation letter at the time of admission. 

  1. Emergency treatment 

In case of an emergency, a family can available a cashless claim by showing the card to a hospital. Now, the hospital will file up the form and submit it to the respective insurer in various ways. An insurance company issues an authorization letter to a hospital mentioning the policy coverage. It will pay the amounts directly to a hospital enabling policyholders to reduce the financial crunches.

Procedure for a reimbursement claim 

A policyholder can apply for medical reimbursement after choosing a hospital that is not included in a network. First, he/she should pay all the medical bills and other costs related to the hospitalization. The next step is submitting all the required bills to an insurer for further investigation. It is imperative to enclose the discharge summary along with other medical bills to get the claims in a quick turnaround time. Apart from that, policyholders should submit the duly filled and signed claim form to claim amounts with ease.

How to check the status of a health insurance claim?

Policyholders can check the status of a health insurance claim by approaching the insurance help desk of the hospital. The hospital authorities will initiate the process and provide the details of deductibles and settle a claim. At the same time, a policyholder can know the status of reimbursement by writing to the insurer. In case of any discrepancy, an insurer will examine the details with more attention and ask policyholders to submit more documents while processing a claim. Sometimes, the insurance claims may get rejected by an insurer, and the insured should know how to avoid them from different sources. 

Things to consider while applying for health insurance claims

Whether it is a planned or emergency treatment, one should intimate an insurer without any delay in cashless claim settlement that will help gain more advantages. A policyholder should inform his/her family about cashless hospitalization in advance that gives ways to plan everything accordingly. It is necessary to ensure that the information provided in a reimbursement claim form is accurate to reduce rejections and other problems. In many cases, an insurer will check the details with professional teams to determine whether they are correct or not.

Which is better: Cashless or reimbursement claims?

cashless claim settlement is the best option for a policyholder because it is quick and eliminates the need for document submission. The only drawback of a cashless claim is that it is available in only listed hospitals of an insurer. At the same time, a policyholder can choose the reimbursement claim both in listed and non-listed hospitals. It gives ways to get admission to any hospital during emergencies to undergo the best treatments. However, the claim process requires more documents while submitting a form to an insurance company. Besides that, the possibilities of rejections are high in reimbursement claims that will result in various problems.

Choosing an insurance plan with a cashless claim 

Customers who want to purchase a new health policy should examine whether it covers a cashless claim or not. This is because it is more convenient, and there is no need to pay the hospital expenses from one’s pocket. A policy buyer should compare the plans online to select a policy at the best price. At the same time, he/she should consider checking the listed hospitals before buying a policy. Reading reviews of insurance companies will help a buyer to get more ideas easily while investing money.

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