Cashless vs Reimbursement Claims in Health Insurance

Health insurance has become an important part of our life. There are various types of health insurance policies that can be customized according to one’s requirements. There are mainly two types of insurance based on the claim settlement process, Cashless and reimbursement claims. Both of which are available in Care health insurance and Care Mediclaim policy provided by Care Insurance.

There are various points which should be considered while choosing between cashless and reimbursement claim. They are:

Claim Settlement Process:

Processes in Cashless Claim Settlement:In a cashless health insurance claim the insurance provider must be informed in advance (in case of planned hospitalization) or as soon as the person is admitted to the hospital. The policyholder must inform the insurance provider or Third-party-agents (TPA’s). A pre-authorization form must also be filled to get approval for treatment. The insurance provider then settles all the hospital expenses incurred.

Processes in Reimbursement Claim Settlement:In a reimbursement claim, the policyholder has to bear all the medical expenses by himself. The policyholder must keep all the bills safely. The discharge receipt is a must to claim the settlement. All the bills along with the settlement form must be submitted to the insurance company. All the documents are then verified and the amount is then reimbursed to the policyholder.

Difference Between Cashless and Reimbursement Claim Settlement:

Hospital Network:In a reimbursement claim, the treatment can be taken in any hospital while in a cashless claim health insurance, the treatment can only be taken in a hospital that falls under the hospital network of the insurance provider.

Responsibility: The policyholder does not have to worry about the bills, as all the expenses are settled cashlessly by the insurance provider. In a reimbursement claim, however, all the bills should be paid by the policyholder which is then submitted to the insurance company for reimbursement.

Claim Settlement time:The claim settlement time in a cashless claim is almost done instantly in the hospital itself. But reimbursement claim takes some time as the bills and the documents are to be verified by the insurance provider.

Although a cashless insurance claim might seem to be better than a reimbursement claim, other factors should be considered before choosing. As you know, a cashless claim will only be beneficial if the treatment is being done in one of the hospitals which fall under the hospital network of the insurance company. This is why an individual needs to choose an insurance provider that has a long chain of hospitals under their name.

One of the main benefits of the reimbursement claim is that the treatment can be done in any hospital. In case of emergencies, you do not have to worry about hospital networks. The reimbursement claim process just becomes a bit tedious during settlement and also takes some time.

In this hectic life, everything just comes down to convenience. This is why people are opting for a cashless claim in health insurance rather than a reimbursement claim. Care Health Insurance, has several health plans to fulfil all your requirements. Each medical policy is suited to cover your medical costs in the best feasible way.