A cashless policy is where the insurer settles the claim directly by making the payment on behalf of the insured. A reimbursement policy requires you to pay for all the expenses first and later reimburses the expenses.
Your health insurance policy will have a network of hospitals across the country. If you get hospitalised in one of these, your policy becomes cashless. This means you just need to show your health insurance card at the hospital and do not need to pay.
This card contains the number of your third-party administrator (TPA) — he works as an intermediary between you and the insurer and helps settle claims. The hospital will fill up the authorisation form with an interim cost structure based on treatment recommended and give it to the TPA, who will then settle the claims
But when you do not go to one of the hospitals that’s empanelled with the insurer, you would usually end up paying hospital bills yourself. But you can produce the bills later and get them reimbursed. For this, you need to get in touch with the TPA or the insurer and produce relevant documents.
FOR SMOOTH SETTLEMENT
As you can’t control what happens at the TPA end, being prompt can make matters easier. In case of a planned hospitalisation, the process of getting the authorisation approved can be initiated in advance. Store the TPA’s number and keep your family in the loop as it helps to get directly in touch with the TPA during emergencies.